Provider Demographics
NPI:1184871873
Name:INDIVIDUALIZED CARE SERVICES
Entity type:Organization
Organization Name:INDIVIDUALIZED CARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:ROSE
Authorized Official - Middle Name:MARY
Authorized Official - Last Name:BENSON-SPANG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:1920-269-7201
Mailing Address - Street 1:N7282 WATERCRESS LN
Mailing Address - Street 2:
Mailing Address - City:BEAVER DAM
Mailing Address - State:WI
Mailing Address - Zip Code:53916
Mailing Address - Country:US
Mailing Address - Phone:920-356-0878
Mailing Address - Fax:920-356-0878
Practice Address - Street 1:N7282 WATERCRESS LN
Practice Address - Street 2:
Practice Address - City:BEAVER DAM
Practice Address - State:WI
Practice Address - Zip Code:53916
Practice Address - Country:US
Practice Address - Phone:920-356-0878
Practice Address - Fax:920-356-0878
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-25
Last Update Date:2008-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health