Provider Demographics
NPI:1215900154
Name:KENOSHA VISITING NURSE ASSOCIATION, INC.
Entity type:Organization
Organization Name:KENOSHA VISITING NURSE ASSOCIATION, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:JENE
Authorized Official - Last Name:HERTZBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:262-656-8400
Mailing Address - Street 1:600 52ND ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53140-3423
Mailing Address - Country:US
Mailing Address - Phone:262-656-8400
Mailing Address - Fax:262-656-8403
Practice Address - Street 1:600 52ND ST
Practice Address - Street 2:SUITE 300
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53140-3423
Practice Address - Country:US
Practice Address - Phone:262-656-8400
Practice Address - Fax:262-656-8403
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI65251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41518600Medicaid
WI527024Medicare ID - Type Unspecified