Provider Demographics
NPI:1417110214
Name:VISITING NURSE ASSOCIATION OF WISCONSIN, INC.
Entity Type:Organization
Organization Name:VISITING NURSE ASSOCIATION OF WISCONSIN, INC.
Other - Org Name:AURORA AT HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SVP
Authorized Official - Prefix:
Authorized Official - First Name:NAN
Authorized Official - Middle Name:
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-299-1610
Mailing Address - Street 1:11333 W NATIONAL AVE
Mailing Address - Street 2:
Mailing Address - City:WEST ALLIS
Mailing Address - State:WI
Mailing Address - Zip Code:53227-3111
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:931 DISCOVERY RD
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54311-8002
Practice Address - Country:US
Practice Address - Phone:920-288-5100
Practice Address - Fax:920-288-2152
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AURORA HEALTH CARE INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-07-02
Last Update Date:2019-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43189500Medicaid
WI43189500Medicaid