Provider Demographics
NPI:1457745960
Name:PROVISIONS HEALTHCARE LLC.
Entity Type:Organization
Organization Name:PROVISIONS HEALTHCARE LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KATIE
Authorized Official - Middle Name:
Authorized Official - Last Name:ANIBAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-450-3391
Mailing Address - Street 1:E2535 CEDAR RD
Mailing Address - Street 2:
Mailing Address - City:ELEVA
Mailing Address - State:WI
Mailing Address - Zip Code:54738-9083
Mailing Address - Country:US
Mailing Address - Phone:715-450-3391
Mailing Address - Fax:
Practice Address - Street 1:E2535 CEDAR RD
Practice Address - Street 2:
Practice Address - City:ELEVA
Practice Address - State:WI
Practice Address - Zip Code:54738-9083
Practice Address - Country:US
Practice Address - Phone:715-450-3391
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-23
Last Update Date:2015-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251300000XAgenciesLocal Education Agency (LEA)
No251F00000XAgenciesHome Infusion
No253Z00000XAgenciesIn Home Supportive Care