Provider Demographics
NPI:1598855207
Name:SHARON S. RICHARDSON HOSPICE HOME, INC
Entity Type:Organization
Organization Name:SHARON S. RICHARDSON HOSPICE HOME, INC
Other - Org Name:SHARON S. RICHARDSON HOSPICE HOME & PALLIATIVE CARE RETREAT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:
Authorized Official - First Name:MARILYN
Authorized Official - Middle Name:L
Authorized Official - Last Name:MASI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-467-7969
Mailing Address - Street 1:W2850 STATE ROAD 28
Mailing Address - Street 2:
Mailing Address - City:SHEBOYGAN FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:53085-2702
Mailing Address - Country:US
Mailing Address - Phone:920-467-1800
Mailing Address - Fax:920-467-1900
Practice Address - Street 1:W2862 STATE ROAD 28
Practice Address - Street 2:
Practice Address - City:SHEBOYGAN FALLS
Practice Address - State:WI
Practice Address - Zip Code:53085
Practice Address - Country:US
Practice Address - Phone:920-467-1800
Practice Address - Fax:920-467-1900
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-13
Last Update Date:2020-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI114429-030163WH1000X
207QH0002X, 251G00000X, 315D00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251G00000XAgenciesHospice Care, Community Based
No163WH1000XNursing Service ProvidersRegistered NurseHospiceGroup - Multi-Specialty
No207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative MedicineGroup - Multi-Specialty
No315D00000XNursing & Custodial Care FacilitiesHospice, InpatientGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43191300Medicaid