Provider Demographics
NPI:1508965328
Name:HOMECARE HEALTH SERVICES INC
Entity Type:Organization
Organization Name:HOMECARE HEALTH SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LYNN
Authorized Official - Middle Name:
Authorized Official - Last Name:SEIDL-BABCOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-684-7155
Mailing Address - Street 1:1004 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:MANITOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:54220-5207
Mailing Address - Country:US
Mailing Address - Phone:920-684-7155
Mailing Address - Fax:
Practice Address - Street 1:1004 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:MANITOWOC
Practice Address - State:WI
Practice Address - Zip Code:54220-5207
Practice Address - Country:US
Practice Address - Phone:920-684-7155
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2010-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI527081Medicare ID - Type UnspecifiedMEDICARE PROVIDER #
WI41523200Medicare ID - Type UnspecifiedWI MEDICAID PROVIDER #