Provider Demographics
NPI:1477964211
Name:INTERIM HEALTH CARE
Entity Type:Organization
Organization Name:INTERIM HEALTH CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED NURSE
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:EICHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-377-9617
Mailing Address - Street 1:594 OUTPOST CIR STE G
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:WI
Mailing Address - Zip Code:54016-7895
Mailing Address - Country:US
Mailing Address - Phone:715-377-9617
Mailing Address - Fax:715-377-9623
Practice Address - Street 1:106 E FRANKLIN AVE
Practice Address - Street 2:
Practice Address - City:BARRON
Practice Address - State:WI
Practice Address - Zip Code:54812-1145
Practice Address - Country:US
Practice Address - Phone:715-637-0166
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-14
Last Update Date:2014-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI124164-030302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization