Kenosha Visiting Nurse Association, Inc.

Primary specialty

Home Health AgencyTaxonomy code 251E00000X

License

65 Issued in WI

Legal business name

KENOSHA VISITING NURSE ASSOCIATION, INC.

Practice address

600 52ND St
Suite 300
Kenosha, WI 53140-3423

Phone

(262) 656-8400

Fax

(262) 656-8403

NPI assigned

Feb 10, 2006

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ms. Debra Jene Hertzberg

Title

President

Phone

(262) 656-8400

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Change-of-ownership history 1

Change of ownership 1

Medicare changes of ownership in which this facility was the buyer or the seller.

• Southport Healthcare LLC

  dba Kenosha Visiting Nurse Association

  • Home Health Agency
  • Kenosha, WI
  • NPI 1285352500

  Sold to, 2022-11-01

  CMS change of ownership

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1139529600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1215900154",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "600 52ND ST",
            "address_2": "SUITE 300",
            "city": "KENOSHA",
            "state": "WI",
            "postal_code": "531403423",
            "telephone_number": "262-656-8400",
            "fax_number": "262-656-8403"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "600 52ND ST",
            "address_2": "SUITE 300",
            "city": "KENOSHA",
            "state": "WI",
            "postal_code": "531403423",
            "telephone_number": "262-656-8400",
            "fax_number": "262-656-8403"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KENOSHA VISITING NURSE ASSOCIATION, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-02-10",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "HERTZBERG",
        "authorized_official_first_name": "DEBRA",
        "authorized_official_middle_name": "JENE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "262-656-8400",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "WI",
            "license": "65",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "41518600",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kenosha Unified School District No. 1
• Kenosha Urgicare
• Kenosha Urology Clinic, S.C.
• Kenosha Vascular Lab Inc
• Kenosha Vascular Laboratory
• Steven Edward Kenzer, D.O.
• Lori J Kerber, DDS
• Rachel Ann Longawa Ketter, PA-C
• Alison M Ketterhagen, PA-C
• Mohamed Aly Khalil

• Home Health Agency in Kenosha, WI
• Providers in Kenosha, WI by specialty
• Home Health Agency in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.