Provider Demographics
NPI:1376241612
Name:BAGO SHORE ENTERPRISES LLC
Entity Type:Organization
Organization Name:BAGO SHORE ENTERPRISES LLC
Other - Org Name:HOME HELPERS HOME CARE OF OSHKOSH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ALYSON
Authorized Official - Middle Name:
Authorized Official - Last Name:WREZINSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:309-824-4247
Mailing Address - Street 1:238 ROOSEVELT ST
Mailing Address - Street 2:
Mailing Address - City:FOND DU LAC
Mailing Address - State:WI
Mailing Address - Zip Code:54935-3646
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:238 ROOSEVELT ST
Practice Address - Street 2:
Practice Address - City:FOND DU LAC
Practice Address - State:WI
Practice Address - Zip Code:54935-3646
Practice Address - Country:US
Practice Address - Phone:309-824-4247
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-16
Last Update Date:2023-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care