Provider Demographics
NPI:1518042597
Name:INTERIM HEALTHCARE SUPPORTIVE SERVICES
Entity Type:Organization
Organization Name:INTERIM HEALTHCARE SUPPORTIVE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JAN
Authorized Official - Middle Name:L
Authorized Official - Last Name:KOCHA
Authorized Official - Suffix:II
Authorized Official - Credentials:
Authorized Official - Phone:715-842-7707
Mailing Address - Street 1:2402 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:WAUSAU
Mailing Address - State:WI
Mailing Address - Zip Code:54403-6918
Mailing Address - Country:US
Mailing Address - Phone:715-842-7707
Mailing Address - Fax:715-842-9890
Practice Address - Street 1:2402 GRAND AVE
Practice Address - Street 2:
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54403-6918
Practice Address - Country:US
Practice Address - Phone:715-842-7707
Practice Address - Fax:715-842-9890
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health