Provider Demographics
NPI:1699292490
Name:HOME AWAY FROM HOME LOVING CARE, LLC
Entity type:Organization
Organization Name:HOME AWAY FROM HOME LOVING CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:BRAEGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-420-2220
Mailing Address - Street 1:1836 N STEVENS ST
Mailing Address - Street 2:
Mailing Address - City:RHINELANDER
Mailing Address - State:WI
Mailing Address - Zip Code:54501-2161
Mailing Address - Country:US
Mailing Address - Phone:715-420-2220
Mailing Address - Fax:715-420-2279
Practice Address - Street 1:1836 N STEVENS ST
Practice Address - Street 2:
Practice Address - City:RHINELANDER
Practice Address - State:WI
Practice Address - Zip Code:54501-2161
Practice Address - Country:US
Practice Address - Phone:715-420-2220
Practice Address - Fax:715-420-2279
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI0016647261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care