52D0722089 CLIA NUMBER - PROHEALTH HOME CARE, INC- HOME HEALTH & HOME HOSPICE

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Laboratory Demographics

CLIA Number: 52D0722089

Facility Name: PROHEALTH HOME CARE, INC- HOME HEALTH & HOME HOSPICE

Facility Address:
N17W24100 RIVERWOOD DR, SUITE 200
WAUKESHA, WI
ZIP 53188
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Facility Phone Number: 262 928-7444

Facility Type: Home Health Agency

Certificate Type: Waiver

NPI Number: 1356316160

Taxonomy: 251G00000X - Hospice Care, Community Based

CLIA Record

Field Name	Field Value
CLIA Number	52D0722089
LAB Type	Home Health Agency
Facility Name	PROHEALTH HOME CARE, INC- HOME HEALTH & HOME HOSPICE
Street	N17W24100 RIVERWOOD DR, SUITE 200
City	WAUKESHA
State	WI
ZIP	53188
Phone	262 928-7444
CertificateType	4
CertificateEffectiveDate	9/1/2022
CertificateExpirationDate	8/31/2024
FacilityType	Waiver

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This page was last updated on: 4/23/2024