Provider Demographics
NPI:1942585567
Name:COMPASSIONATE HOME HEALTH CARE INC
Entity Type:Organization
Organization Name:COMPASSIONATE HOME HEALTH CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/O
Authorized Official - Prefix:MRS
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:RISTOW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-257-4383
Mailing Address - Street 1:5601 W GRANDE MARKET DR
Mailing Address - Street 2:SUITE M
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54913-8511
Mailing Address - Country:US
Mailing Address - Phone:920-257-4383
Mailing Address - Fax:
Practice Address - Street 1:5601 W GRANDE MARKET DR
Practice Address - Street 2:SUITE M
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54913-8511
Practice Address - Country:US
Practice Address - Phone:920-257-4383
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-14
Last Update Date:2011-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1000017393251E00000X
WI164W00000X251E00000X
WI376K00000X251E00000X
WI372600000X251E00000X, 253Z00000X
WI37400000X253Z00000X
WI376J00000X253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1000017393Medicaid