Provider Demographics
NPI:1568469070
Name:RECOVER HEALTH OF WISCONSIN, INC.
Entity Type:Organization
Organization Name:RECOVER HEALTH OF WISCONSIN, INC.
Other - Org Name:AVEANNA HOME HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF LEGAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:
Authorized Official - Last Name:DRAKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:470-464-8000
Mailing Address - Street 1:400 INTERSTATE NORTH PKWY SE STE 1600
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339-5047
Mailing Address - Country:US
Mailing Address - Phone:470-464-8000
Mailing Address - Fax:
Practice Address - Street 1:660 W WASHINGTON AVE STE 309
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53703-4703
Practice Address - Country:US
Practice Address - Phone:608-274-8193
Practice Address - Fax:608-274-8717
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RECOVER HEALTH, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-06-30
Last Update Date:2024-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100066021Medicaid
WI41534400Medicaid
WI100066025Medicaid
WI41534400Medicaid