Provider Demographics
NPI:1790788099
Name:DOVE INC
Entity Type:Organization
Organization Name:DOVE INC
Other - Org Name:THE DOVE INC
Other - Org Type:Other Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:GREG
Authorized Official - Middle Name:ANSELM
Authorized Official - Last Name:LEIVISKA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-392-3133
Mailing Address - Street 1:1416 CUMMING AVE
Mailing Address - Street 2:STE 2B
Mailing Address - City:SUPERIOR
Mailing Address - State:WI
Mailing Address - Zip Code:54880-3757
Mailing Address - Country:US
Mailing Address - Phone:715-392-3133
Mailing Address - Fax:715-392-3190
Practice Address - Street 1:1416 CUMMING AVE
Practice Address - Street 2:STE 2B
Practice Address - City:SUPERIOR
Practice Address - State:WI
Practice Address - Zip Code:54880-3757
Practice Address - Country:US
Practice Address - Phone:715-392-3133
Practice Address - Fax:715-392-3190
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-31
Last Update Date:2010-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI172251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41531900Medicaid
WI41531900Medicaid