Provider Demographics
NPI:1699109124
Name:LA SANTE WISCONSIN, INC.
Entity type:Organization
Organization Name:LA SANTE WISCONSIN, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:ARNOLD
Authorized Official - Last Name:HELGESON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-320-3104
Mailing Address - Street 1:PO BOX 1415
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54305-1415
Mailing Address - Country:US
Mailing Address - Phone:920-465-3000
Mailing Address - Fax:920-465-3003
Practice Address - Street 1:1337 N TAYLOR DR STE 103
Practice Address - Street 2:
Practice Address - City:SHEBOYGAN
Practice Address - State:WI
Practice Address - Zip Code:53081-3012
Practice Address - Country:US
Practice Address - Phone:888-719-5788
Practice Address - Fax:855-837-5265
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LA SANTE WISCONSIN, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-09-03
Last Update Date:2022-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2583-45332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI0485480002Medicare NSC