Provider Demographics
NPI:1245277144
Name:MINISTRY HOME CARE LLC
Entity type:Organization
Organization Name:MINISTRY HOME CARE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SVP CHIEF LEGAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:
Authorized Official - Last Name:ADKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-309-5668
Mailing Address - Street 1:303 W UPHAM ST STE 208
Mailing Address - Street 2:
Mailing Address - City:MARSHFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:54449-1483
Mailing Address - Country:US
Mailing Address - Phone:715-301-7260
Mailing Address - Fax:844-887-0042
Practice Address - Street 1:303 W UPHAM ST
Practice Address - Street 2:SUITE 208
Practice Address - City:MARSHFIELD
Practice Address - State:WI
Practice Address - Zip Code:54449-1483
Practice Address - Country:US
Practice Address - Phone:715-301-7260
Practice Address - Fax:844-887-0042
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-31
Last Update Date:2021-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI182251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41535000Medicaid
WI41535000Medicaid