Provider Demographics
NPI:1790934651
Name:HOUSE CALLS OF MENOMONIE, INC.
Entity Type:Organization
Organization Name:HOUSE CALLS OF MENOMONIE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:R
Authorized Official - Last Name:NOLL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-232-6475
Mailing Address - Street 1:PO BOX 361
Mailing Address - Street 2:1421 N BROADWAY AVENUE, SUITE 111
Mailing Address - City:MENOMONIE
Mailing Address - State:WI
Mailing Address - Zip Code:54751-0361
Mailing Address - Country:US
Mailing Address - Phone:715-232-6475
Mailing Address - Fax:715-232-6477
Practice Address - Street 1:1421 N BROADWAY AVE
Practice Address - Street 2:SUITE 111
Practice Address - City:MENOMONIE
Practice Address - State:WI
Practice Address - Zip Code:54751-0361
Practice Address - Country:US
Practice Address - Phone:715-232-6475
Practice Address - Fax:715-232-6477
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-16
Last Update Date:2008-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI7917800251V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI7917800OtherCHARTABLE ORGANIZATION