Organization
OCONOMOWOC HOME HEALTH CARE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RICHARD SUMMERS MACNALLY (DIRECTOR)
(262) 569-5520
Entity
Organization
Contact information
Practice address
1746 EXECUTIVE DR, OCONOMOWOC, WI 53066-4830
(262) 569-5520
(262) 569-6339
Mailing address
PO BOX 278, DOUSMAN, WI 53118-0278
(262) 569-5520
(262) 569-6339
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
1025
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1025
HOME HEALTH LICENSE
WI
05
—
41537600
—
WI
Enumeration date
01/05/2006
Last updated
08/22/2020
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