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52D2101804 CLIA NUMBER - CARE IN THE HOME WISCONSIN

Laboratory Demographics

CLIA Number: 52D2101804

Facility Name: CARE IN THE HOME WISCONSIN

Facility Address:
10505 CORPORATE DR, STE 102
PLEASANT PRAIRIE, WI
ZIP 53158
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Facility Phone Number: 877 848-1705

Facility Type: Home Health Agency

Certificate Type: Waiver
NPI Number: 1558733097

Taxonomy: 251E00000X - Home Health
A public agency or private organization, or a subdivision of such an agency or organization, that is primarily engaged in providing skilled nursing services and other therapeutic services, such as physical therapy, speech-language pathology services, or occupational therapy, medical social services, and home health aide services. It has policies established by a professional group associated with the agency or organization (including at least one physician and one registered nurse) to govern the services and provides for supervision of such services by a physician or a registered nurse; maintains clinical records on all patients; is licensed in accordance with State or local law or is approved by the State or local licensing agency as meeting the licensing standards, where applicable; and meets other conditions found by the Secretary of Health and Human Services to be necessary for health and safety.

CLIA Record

Field Name Field Value
CLIA Number 52D2101804
LAB Type Home Health Agency
Facility Name CARE IN THE HOME WISCONSIN
Street 10505 CORPORATE DR, STE 102
City PLEASANT PRAIRIE
State WI
ZIP 53158
Phone 877 848-1705
CertificateType 4
CertificateEffectiveDate 9/10/2023
CertificateExpirationDate 9/9/2025
FacilityType Waiver

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