Provider Demographics
NPI:1649974908
Name:INDEPENDENCE CARE OF WISCONSIN LLC
Entity type:Organization
Organization Name:INDEPENDENCE CARE OF WISCONSIN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALLISON
Authorized Official - Middle Name:
Authorized Official - Last Name:VIAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:845-559-3081
Mailing Address - Street 1:1016 COLLIER CENTER WAY STE 206
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34110-8473
Mailing Address - Country:US
Mailing Address - Phone:603-520-1603
Mailing Address - Fax:
Practice Address - Street 1:1366 E SUMNER ST
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:WI
Practice Address - Zip Code:53027-1614
Practice Address - Country:US
Practice Address - Phone:845-559-3081
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-29
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health