Provider Demographics
NPI:1588766877
Name:FAMILY NURSECARE OF OF WISCONSIN, LLC
Entity type:Organization
Organization Name:FAMILY NURSECARE OF OF WISCONSIN, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:MITCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-893-0500
Mailing Address - Street 1:27000 HILLS TECH CT
Mailing Address - Street 2:STE 200
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48331-3412
Mailing Address - Country:US
Mailing Address - Phone:248-893-0500
Mailing Address - Fax:248-324-1477
Practice Address - Street 1:2448 S 102ND ST
Practice Address - Street 2:STE. 270
Practice Address - City:WEST ALLIS
Practice Address - State:WI
Practice Address - Zip Code:53227-2466
Practice Address - Country:US
Practice Address - Phone:414-543-9600
Practice Address - Fax:414-543-9601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health