Provider Demographics
NPI:1396909610
Name:REST ASSURED HOME HEALTH CARE LLC
Entity type:Organization
Organization Name:REST ASSURED HOME HEALTH CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:L
Authorized Official - Last Name:DITTBERNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-516-9337
Mailing Address - Street 1:W12250 HILLCREST DR
Mailing Address - Street 2:
Mailing Address - City:LODI
Mailing Address - State:WI
Mailing Address - Zip Code:53555-9329
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:215 NORTHRIDGE DR
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:WI
Practice Address - Zip Code:53901-9294
Practice Address - Country:US
Practice Address - Phone:608-516-9337
Practice Address - Fax:608-745-0333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-16
Last Update Date:2008-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health