Provider Demographics
NPI:1992312946
Name:INDEPENDENCE PLUS- WI, LLC
Entity type:Organization
Organization Name:INDEPENDENCE PLUS- WI, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DANILO
Authorized Official - Middle Name:R
Authorized Official - Last Name:COITE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-366-7696
Mailing Address - Street 1:800 JORIE BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:OAK BROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60523-2252
Mailing Address - Country:US
Mailing Address - Phone:800-366-7696
Mailing Address - Fax:
Practice Address - Street 1:N19W24400 RIVERWOOD DR STE 350
Practice Address - Street 2:
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53188-1182
Practice Address - Country:US
Practice Address - Phone:800-366-7696
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:INDEPENDENCE PLUS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-09-24
Last Update Date:2020-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
No251E00000XAgenciesHome Health