International Quality Homecare of Wisconsin LLC

Primary specialty

Home Health AgencyTaxonomy code 251E00000X

Legal business name

INTERNATIONAL QUALITY HOMECARE OF WISCONSIN LLC

Practice address

2395 W Washington St Ste 103
West Bend, WI 53095-2147

Phone

(866) 677-0590

NPI assigned

Mar 5, 2019

Organization subpart

No

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

Authorized official

Name

Jayne Johnson, BS

Title

Compliance Director

Phone

(507) 252-8151

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in WI

Enrollment records 1

Home health agency certification: CCN 527339

Legal name

INTERNATIONAL QUALITY HOMECARE OF WISCONSIN, LLC

Certification status

Active

Provider type (POS)

Home health agency

Participating since

Aug 14, 2020

Last certification

Aug 14, 2020

Ownership / control type

Proprietary

Organization structure

LLCProprietary

Incorporated

Aug 16, 2015 in WI

Enrollment address

2395 W Washington St
West Bend, WI 53095-2147

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

• International Quality Homecare of Wisconsin LLC

  • Home Health Agency
  • Stevens Point, WI
  • NPI 1427401728

  8022398874

  Same PAC ID

Listed as

International Quality Homecare of Wisconsin, LLCCCN 527339

Ownership

Proprietary

Certified

Aug 14, 2020

Medicare certification status

ActiveFrom the Provider of Services file

Services

Nursing, Medical social, Home health aide, Physical therapy, Speech pathology, Occupational therapy

Locations

All disclosed owners & managing parties 2

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

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

{
    "created_epoch": "1551744000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1551744000000",
    "number": "1225596646",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3261 19TH ST NW",
            "city": "ROCHESTER",
            "state": "MN",
            "postal_code": "559016786",
            "telephone_number": "507-252-8117"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2395 W WASHINGTON ST STE 103",
            "city": "WEST BEND",
            "state": "WI",
            "postal_code": "530952147",
            "telephone_number": "866-677-0590"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTERNATIONAL QUALITY HOMECARE OF WISCONSIN LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-03-05",
        "last_updated": "2019-03-05",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "JAYNE",
        "authorized_official_title_or_position": "COMPLIANCE DIRECTOR",
        "authorized_official_telephone_number": "507-252-8151",
        "authorized_official_credential": "BS"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Independent Physicians of Wisconsin LLC
• Infinity Healthcare Physicians, S.C.
• Inner Peace Counseling and Wellness LLC
• Integrated Life Counseling Center, LLC
• International Quality Homecare Corp
• Shannon Jacklin, APNP
• Zachery Lazar Jacober, D.C.
• Bonnie Lee Jacobs, MSW LCSW
• Jennifer Jacobson
• Renee R Jahnke, M.D.

• Home Health Agency in West Bend, WI
• Providers in West Bend, 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 Mar 5, 2019; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.