Provider Demographics
NPI:1508901158
Name:HOMME HOME FOR THE AGING INC.
Entity Type:Organization
Organization Name:HOMME HOME FOR THE AGING INC.
Other - Org Name:HOMME HOME OF WITTENBERG
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:RODNEY
Authorized Official - Middle Name:
Authorized Official - Last Name:WENDORF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-253-2125
Mailing Address - Street 1:604 S WEBB ST
Mailing Address - Street 2:
Mailing Address - City:WITTENBERG
Mailing Address - State:WI
Mailing Address - Zip Code:54499-9040
Mailing Address - Country:US
Mailing Address - Phone:715-253-2125
Mailing Address - Fax:715-253-3538
Practice Address - Street 1:604 S WEBB ST
Practice Address - Street 2:
Practice Address - City:WITTENBERG
Practice Address - State:WI
Practice Address - Zip Code:54499-9040
Practice Address - Country:US
Practice Address - Phone:715-253-2125
Practice Address - Fax:715-253-3538
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI306314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI20-153700Medicaid
WI52-5527Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER