Provider Demographics
NPI:1528497799
Name:HOPE HOUSING OF SHAWANO COUNTY AND WISCONSIN-USA
Entity type:Organization
Organization Name:HOPE HOUSING OF SHAWANO COUNTY AND WISCONSIN-USA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EX DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:CROWLEY
Authorized Official - Suffix:I
Authorized Official - Credentials:STREET SMART
Authorized Official - Phone:414-553-5247
Mailing Address - Street 1:2153 N 36TH ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53208-1406
Mailing Address - Country:US
Mailing Address - Phone:414-553-5247
Mailing Address - Fax:
Practice Address - Street 1:2153 N 36TH ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53208-1406
Practice Address - Country:US
Practice Address - Phone:414-553-5247
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HOPE HOUSE.US
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-11-07
Last Update Date:2014-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI251C00000X, 302F00000X, 347C00000X, 374U00000X
253Z00000X, 251X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251X00000XAgenciesSupports BrokerageGroup - Single Specialty
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No302F00000XManaged Care OrganizationsExclusive Provider Organization
No347C00000XTransportation ServicesPrivate Vehicle
No374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty
No253Z00000XAgenciesIn Home Supportive Care