Provider Demographics
NPI:1356316160
Name:PROHEALTH HOME CARE, INC.
Entity type:Organization
Organization Name:PROHEALTH HOME CARE, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR, PROHEALTH HOME CARE, INC.
Authorized Official - Prefix:
Authorized Official - First Name:JILL
Authorized Official - Middle Name:M
Authorized Official - Last Name:JOHNSTON
Authorized Official - Suffix:
Authorized Official - Credentials:RN, MBA
Authorized Official - Phone:262-928-8831
Mailing Address - Street 1:N17W24100 RIVERWOOD DR STE 200
Mailing Address - Street 2:
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53188-1187
Mailing Address - Country:US
Mailing Address - Phone:262-928-7444
Mailing Address - Fax:262-928-7446
Practice Address - Street 1:N17W24100 RIVERWOOD DR STE 200
Practice Address - Street 2:
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53188-1187
Practice Address - Country:US
Practice Address - Phone:262-928-7444
Practice Address - Fax:262-928-7446
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-23
Last Update Date:2025-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI527251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI7200001OtherUNITED HEALTH CARE
WI43183600Medicaid
WI43183600Medicaid