Provider Demographics
NPI:1609328699
Name:PEDERSON HOMECARE LLC BDA VISITING ANGELS
Entity Type:Organization
Organization Name:PEDERSON HOMECARE LLC BDA VISITING ANGELS
Other - Org Name:VISITING ANGELS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:
Authorized Official - Last Name:PEDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-525-4881
Mailing Address - Street 1:7761 W. RYAN ROAD
Mailing Address - Street 2:210
Mailing Address - City:FRANKLIN
Mailing Address - State:WI
Mailing Address - Zip Code:53132
Mailing Address - Country:US
Mailing Address - Phone:414-525-4881
Mailing Address - Fax:414-525-4882
Practice Address - Street 1:7761 W RYAN RD
Practice Address - Street 2:210
Practice Address - City:FRANKLIN
Practice Address - State:WI
Practice Address - Zip Code:53132-9520
Practice Address - Country:US
Practice Address - Phone:414-525-4881
Practice Address - Fax:414-525-4882
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-26
Last Update Date:2016-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care