Provider Demographics
NPI:1407853112
Name:SEASONS HOSPICE & PALLIATIVE CARE OF WISCONSIN, LLC
Entity Type:Organization
Organization Name:SEASONS HOSPICE & PALLIATIVE CARE OF WISCONSIN, LLC
Other - Org Name:ACCENTCARE HOSPICE & PALLIATIVE CARE OF WISCONSIN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP LEGAL
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:
Authorized Official - Last Name:SISCEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:224-221-0465
Mailing Address - Street 1:6400 SHAFER CT
Mailing Address - Street 2:STE 700
Mailing Address - City:ROSEMONT
Mailing Address - State:IL
Mailing Address - Zip Code:60018-4914
Mailing Address - Country:US
Mailing Address - Phone:847-759-9449
Mailing Address - Fax:847-375-2148
Practice Address - Street 1:6737 W WASHINGTON ST
Practice Address - Street 2:SUITE 2150
Practice Address - City:WEST ALLIS
Practice Address - State:WI
Practice Address - Zip Code:53214-5647
Practice Address - Country:US
Practice Address - Phone:414-203-8310
Practice Address - Fax:414-203-8311
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-07
Last Update Date:2021-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2008251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43189800Medicaid
WI521571Medicare ID - Type UnspecifiedHOSPICE
WI43189800Medicaid