Provider Demographics
NPI:1417610148
Name:HOMECARE HUB OF WISCONSIN, LLC
Entity Type:Organization
Organization Name:HOMECARE HUB OF WISCONSIN, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TAMI
Authorized Official - Middle Name:
Authorized Official - Last Name:ZUBILLAGA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:515-985-2310
Mailing Address - Street 1:1576 BELLA CRUZ DR STE 319
Mailing Address - Street 2:
Mailing Address - City:THE VILLAGES
Mailing Address - State:FL
Mailing Address - Zip Code:32159-8969
Mailing Address - Country:US
Mailing Address - Phone:515-985-2310
Mailing Address - Fax:
Practice Address - Street 1:2800 E ENTERPRISE AVE STE 333
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54913-7889
Practice Address - Country:US
Practice Address - Phone:484-643-0757
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-19
Last Update Date:2022-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care