Provider Demographics
NPI:1346233988
Name:LA SANTE WISCONSIN, INC.
Entity Type:Organization
Organization Name:LA SANTE WISCONSIN, INC.
Other - Org Name:HME HOME MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:A
Authorized Official - Last Name:BYE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-465-3000
Mailing Address - Street 1:PO BOX 1415
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54305-1415
Mailing Address - Country:US
Mailing Address - Phone:920-465-3000
Mailing Address - Fax:920-465-3003
Practice Address - Street 1:2021 RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54301-2320
Practice Address - Country:US
Practice Address - Phone:920-465-3000
Practice Address - Fax:920-465-3003
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LA SANTE WISCONSIN, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-08-30
Last Update Date:2016-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2584-45332B00000X, 332BX2000X
WI258445332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41641300Medicaid
WI0485480001Medicare NSC