Provider Demographics
NPI:1558733097
Name:RESPITECARE-CARE IN THE HOME, INC
Entity Type:Organization
Organization Name:RESPITECARE-CARE IN THE HOME, INC
Other - Org Name:CARE IN THE HOME WISCONSIN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:
Authorized Official - Last Name:KELLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-256-1705
Mailing Address - Street 1:1200 CENTRAL AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WILMETTE
Mailing Address - State:IL
Mailing Address - Zip Code:60091-2683
Mailing Address - Country:US
Mailing Address - Phone:847-256-1705
Mailing Address - Fax:
Practice Address - Street 1:10505 CORPORATE DR
Practice Address - Street 2:SUITE 102
Practice Address - City:PLEASANT PRAIRIE
Practice Address - State:WI
Practice Address - Zip Code:53158-1605
Practice Address - Country:US
Practice Address - Phone:262-857-3705
Practice Address - Fax:262-857-2688
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RESPITECARE-CARE IN THE HOME, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-10-23
Last Update Date:2021-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI251E00000X, 251F00000X, 251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251F00000XAgenciesHome Infusion
No251J00000XAgenciesNursing Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL147719Medicare PIN