Provider Demographics
NPI:1215229604
Name:INTERIM HOSPICE & PALLIATIVE CARE
Entity Type:Organization
Organization Name:INTERIM HOSPICE & PALLIATIVE CARE
Other - Org Name:INTERIM HOSPICE AND PALLIATIVE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:JEANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:BYL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-410-6040
Mailing Address - Street 1:510 N 17TH AVE STE A
Mailing Address - Street 2:
Mailing Address - City:WAUSAU
Mailing Address - State:WI
Mailing Address - Zip Code:54401-4254
Mailing Address - Country:US
Mailing Address - Phone:715-842-7707
Mailing Address - Fax:715-842-9890
Practice Address - Street 1:510 N 17TH AVE STE A
Practice Address - Street 2:
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54401
Practice Address - Country:US
Practice Address - Phone:715-842-7707
Practice Address - Fax:715-842-9890
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KOCHAS INTERIM HEALTHCARE, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-05-04
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251G00000XAgenciesHospice Care, Community Based
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WII027003OtherSTATE OF WISCONSIN DEPARTMENT OF FINANCIAL INSTITUTIONS