Provider Demographics
NPI:1881623981
Name:NORTH END HOME MEDICAL SERVICES, LLC
Entity type:Organization
Organization Name:NORTH END HOME MEDICAL SERVICES, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:HERZOG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-320-3484
Mailing Address - Street 1:3310 CALUMET AVE
Mailing Address - Street 2:
Mailing Address - City:MANITOWOC
Mailing Address - State:WI
Mailing Address - Zip Code:54220-5426
Mailing Address - Country:US
Mailing Address - Phone:920-320-4450
Mailing Address - Fax:920-320-4498
Practice Address - Street 1:3310 CALUMET AVE
Practice Address - Street 2:
Practice Address - City:MANITOWOC
Practice Address - State:WI
Practice Address - Zip Code:54220-5426
Practice Address - Country:US
Practice Address - Phone:920-320-4450
Practice Address - Fax:920-320-4498
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NORTH END HOME MEDICAL SERVICES, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-01
Last Update Date:2011-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41695900Medicaid
WI1157670002Medicare NSC