Organization
SOUTHPORT HEALTHCARE LLC
Active
Other names
Kenosha Visiting Nurse Association
Organization subpart
No
Provider details
NPI number
Authorized official
AMBER L TUELLER (CORPORATE SECRETARY)
(208) 401-1400
Entity
Organization
Contact information
Practice address
600 52ND ST STE 300, KENOSHA, WI 53140-3423
(262) 656-8400
Mailing address
600 52ND ST STE 300, KENOSHA, WI 53140-3423
(262) 656-8400
Taxonomy
Speciality
Code
Description
License number
State
251G00000X
Community Based Hospice Care Agency
Primary
—
—
Other
Enumeration date
05/15/2024
Last updated
05/15/2024
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