Provider Demographics
NPI:1427401728
Name:INTERNATIONAL QUALITY HOMECARE OF WISCONSIN LLC
Entity Type:Organization
Organization Name:INTERNATIONAL QUALITY HOMECARE OF WISCONSIN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ADERONKE
Authorized Official - Middle Name:OLANREWAJU
Authorized Official - Last Name:MORDI
Authorized Official - Suffix:
Authorized Official - Credentials:PHD,MBA, RN
Authorized Official - Phone:507-252-8117
Mailing Address - Street 1:3261 19TH ST NW
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55901-6786
Mailing Address - Country:US
Mailing Address - Phone:507-252-8117
Mailing Address - Fax:507-252-1985
Practice Address - Street 1:5600 WOODLAND ST
Practice Address - Street 2:STE 3C
Practice Address - City:STEVENS POINT
Practice Address - State:WI
Practice Address - Zip Code:54482-9317
Practice Address - Country:US
Practice Address - Phone:888-544-2282
Practice Address - Fax:715-544-0077
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-21
Last Update Date:2016-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1201251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health