Statewide Group Homes LLC

Primary specialty

In Home Supportive Care AgencyTaxonomy code 253Z00000X

Legal business name

STATEWIDE GROUP HOMES LLC

Practice address

2412 S Greenview St
Appleton, WI 54915-4831

Phone

(920) 214-9159

NPI assigned

Mar 11, 2024

Organization subpart

No

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

Authorized official

Name

Mr. Mohamed Hassan Abdillahi

Title

Ceo

Phone

(774) 297-0139

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1710115200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1710115200000",
    "number": "1447018817",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2412 S GREENVIEW ST",
            "city": "APPLETON",
            "state": "WI",
            "postal_code": "549154831"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2412 S GREENVIEW ST",
            "city": "APPLETON",
            "state": "WI",
            "postal_code": "549154831",
            "telephone_number": "920-214-9159"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STATEWIDE GROUP HOMES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-03-11",
        "last_updated": "2024-03-11",
        "certification_date": "2024-03-11",
        "status": "A",
        "authorized_official_last_name": "ABDILLAHI",
        "authorized_official_first_name": "MOHAMED",
        "authorized_official_middle_name": "HASSAN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "774-297-0139",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "253Z00000X",
            "taxonomy_group": "",
            "desc": "In Home Supportive Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Roger Gary Stanek, D.D.S.
• Eric Jon Stanelle, M.D.
• Ryan Stanke, PHARMD
• Star Bright Therapy LLC
• Mary Jo Stastny, MD
• C Danae Steele
• Bailey Stefancic, SAC-IT
• Linda J. Steffen, PSY.D.
• Joseph Steffens
• Heather Christine Steffes, D.C.

• In Home Supportive Care Agency in Appleton, WI
• Providers in Appleton, WI by specialty
• In Home Supportive Care Agency in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 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.