Roena Angela Waters, ADULT FAMILY HOME

Primary specialty

Home Health AgencyTaxonomy code 251E00000X

License

0019382 Issued in WI

Practice address

4910 63Rd Ave
Kenosha, WI 53144-1709

Phone

(262) 351-5955

Fax

(262) 222-2399

NPI assigned

Oct 28, 2024

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1730073600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1730073600000",
    "number": "1366264624",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4910 63RD AVE",
            "city": "KENOSHA",
            "state": "WI",
            "postal_code": "531441709",
            "telephone_number": "262-351-5955",
            "fax_number": "262-222-2399"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4910 63RD AVE",
            "city": "KENOSHA",
            "state": "WI",
            "postal_code": "531441709",
            "telephone_number": "262-351-5955",
            "fax_number": "262-222-2399"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WATERS",
        "first_name": "ROENA",
        "middle_name": "ANGELA",
        "credential": "ADULT FAMILY HOME",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-10-28",
        "last_updated": "2024-10-28",
        "certification_date": "2024-10-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "WI",
            "license": "0019382",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Michael Anthony Walsh, D.D.S.
• John James Walther, BS
• Clinton Charles Warren, M.D.
• Eileen G Warren, MS, CSAC - ICS
• Melanie Waschbisch, LPC
• Jason T Watka
• Brian M Watkins, PTA
• We Care Consulting Inc. (We Care Counseling and Consulting)
• Carly Weber
• Kimberly S Weber, MSW, APSW

• 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 Oct 28, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.