Provider Demographics
NPI:1922874874
Name:JOURNEY OF PEACE HOMECARE LLC
Entity Type:Organization
Organization Name:JOURNEY OF PEACE HOMECARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:
Authorized Official - Last Name:MOUSSEAU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-336-3111
Mailing Address - Street 1:311 E GRANT ST
Mailing Address - Street 2:
Mailing Address - City:POYNETTE
Mailing Address - State:WI
Mailing Address - Zip Code:53955-8938
Mailing Address - Country:US
Mailing Address - Phone:608-336-3111
Mailing Address - Fax:
Practice Address - Street 1:311 E GRANT ST
Practice Address - Street 2:
Practice Address - City:POYNETTE
Practice Address - State:WI
Practice Address - Zip Code:53955-8938
Practice Address - Country:US
Practice Address - Phone:608-336-3111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-01
Last Update Date:2023-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100231717Medicaid