Provider Demographics
NPI:1972752517
Name:HOME INSTEAD SENIOR CARE
Entity Type:Organization
Organization Name:HOME INSTEAD SENIOR CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:M
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-552-8040
Mailing Address - Street 1:515 S BARSTOW ST
Mailing Address - Street 2:SUITE 116
Mailing Address - City:EAU CLAIRE
Mailing Address - State:WI
Mailing Address - Zip Code:54701-3600
Mailing Address - Country:US
Mailing Address - Phone:715-552-8040
Mailing Address - Fax:715-552-7660
Practice Address - Street 1:515 S BARSTOW ST
Practice Address - Street 2:SUITE 116
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54701-3600
Practice Address - Country:US
Practice Address - Phone:715-552-8040
Practice Address - Fax:715-552-7660
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-18
Last Update Date:2008-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5920913251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health