Provider Demographics
NPI:1669474821
Name:HANNAH HOME HEALTH CARE, INC.
Entity Type:Organization
Organization Name:HANNAH HOME HEALTH CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:HANNAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:262-363-2500
Mailing Address - Street 1:318 N ROCHESTER ST
Mailing Address - Street 2:
Mailing Address - City:MUKWONAGO
Mailing Address - State:WI
Mailing Address - Zip Code:53149-1343
Mailing Address - Country:US
Mailing Address - Phone:262-363-2500
Mailing Address - Fax:262-363-3199
Practice Address - Street 1:318 N ROCHESTER ST
Practice Address - Street 2:
Practice Address - City:MUKWONAGO
Practice Address - State:WI
Practice Address - Zip Code:53149-1343
Practice Address - Country:US
Practice Address - Phone:262-363-2500
Practice Address - Fax:262-363-3199
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-01
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI240251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41526900Medicaid
WI41526900Medicaid
WI=========013OtherBLUE CROSS & BLUE SHIELD