Individual Care Services LLC

Primary specialty

In Home Supportive Care AgencyTaxonomy code 253Z00000X

Legal business name

INDIVIDUAL CARE SERVICES LLC

Practice address

133 Haskell St
Beaver Dam, WI 53916-1609

Phone

(920) 296-6556

NPI assigned

Jun 26, 2015

Last updated

Jun 26, 2015By 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

Mr. Roy Milburn Profitt IV

Title

Member

Phone

(920) 296-6556

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1435276800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1435276800000",
    "number": "1841672755",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "133 HASKELL ST",
            "city": "BEAVER DAM",
            "state": "WI",
            "postal_code": "539161609"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "133 HASKELL ST",
            "city": "BEAVER DAM",
            "state": "WI",
            "postal_code": "539161609",
            "telephone_number": "920-296-6556"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INDIVIDUAL CARE SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-06-26",
        "last_updated": "2015-06-26",
        "status": "A",
        "authorized_official_last_name": "PROFITT",
        "authorized_official_first_name": "ROY",
        "authorized_official_middle_name": "MILBURN",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "920-296-6556",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "IV"
    },
    "taxonomies": [
        {
            "code": "253Z00000X",
            "taxonomy_group": "",
            "desc": "In Home Supportive Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Carley Ann Jahnke, APNP
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• In Home Supportive Care Agency in Beaver Dam, WI
• Providers in Beaver Dam, 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 Jun 26, 2015; 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.