Firstlight of West Bend, Wi

Primary specialty

In Home Supportive Care AgencyTaxonomy code 253Z00000X

Legal business name

FIRSTLIGHT OF WEST BEND, WI

Practice address

W175N11163 Stonewood Dr Ste 208
Germantown, WI 53022-6502

Phone

(262) 299-5989

NPI assigned

Apr 17, 2019

Organization subpart

No

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

Authorized official

Name

Mrs. Kelly Renee Gengler

Title

Owner

Phone

(920) 979-5640

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1555459200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1575331200000",
    "number": "1619530474",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "310 S MILWAUKEE ST",
            "city": "THERESA",
            "state": "WI",
            "postal_code": "530919663",
            "telephone_number": "920-276-2019"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "W175N11163 STONEWOOD DR STE 208",
            "city": "GERMANTOWN",
            "state": "WI",
            "postal_code": "530226502",
            "telephone_number": "262-299-5989"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FIRSTLIGHT OF WEST BEND, WI",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-04-17",
        "last_updated": "2019-12-03",
        "status": "A",
        "authorized_official_last_name": "GENGLER",
        "authorized_official_first_name": "KELLY",
        "authorized_official_middle_name": "RENEE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "920-979-5640",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "253Z00000X",
            "taxonomy_group": "",
            "desc": "In Home Supportive Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 3, 2019; 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.