Provider Demographics
NPI:1629294129
Name:PREFERRED HOME HEALTH CARE, INC
Entity Type:Organization
Organization Name:PREFERRED HOME HEALTH CARE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER ADMINSTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:M
Authorized Official - Last Name:SCHAEFERS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:920-725-1116
Mailing Address - Street 1:1476 KENWOOD CTR
Mailing Address - Street 2:
Mailing Address - City:MENASHA
Mailing Address - State:WI
Mailing Address - Zip Code:54952-1134
Mailing Address - Country:US
Mailing Address - Phone:920-725-1116
Mailing Address - Fax:920-725-1146
Practice Address - Street 1:1476 KENWOOD CTR
Practice Address - Street 2:
Practice Address - City:MENASHA
Practice Address - State:WI
Practice Address - Zip Code:54952-1134
Practice Address - Country:US
Practice Address - Phone:920-725-1116
Practice Address - Fax:920-725-1146
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2011-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI157251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41530000Medicaid
WI527166Medicare ID - Type Unspecified