Provider Demographics
NPI:1700564937
Name:LILY HOME AND HOSPICE
Entity type:Organization
Organization Name:LILY HOME AND HOSPICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:
Authorized Official - Last Name:RASIMUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-201-2233
Mailing Address - Street 1:15430 W CAPITOL DR STE 100
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53005-2626
Mailing Address - Country:US
Mailing Address - Phone:262-235-3115
Mailing Address - Fax:262-537-5140
Practice Address - Street 1:4423 GOLF TER STE A
Practice Address - Street 2:
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54701-4902
Practice Address - Country:US
Practice Address - Phone:262-421-6004
Practice Address - Fax:262-537-5140
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-07
Last Update Date:2024-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based