Provider Demographics
NPI:1891142865
Name:HHA OF WISCONSIN, LLC
Entity type:Organization
Organization Name:HHA OF WISCONSIN, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:L
Authorized Official - Last Name:PROFFITT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-233-1307
Mailing Address - Street 1:PO BOX 51266
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70505-1266
Mailing Address - Country:US
Mailing Address - Phone:800-489-1307
Mailing Address - Fax:337-233-5764
Practice Address - Street 1:3615 N HASTINGS WAY STE 100A
Practice Address - Street 2:
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54703-0474
Practice Address - Country:US
Practice Address - Phone:715-831-0631
Practice Address - Fax:715-831-0639
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HHA OF WISCONSIN, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-05-19
Last Update Date:2025-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100061690Medicaid