1700019387 NPI number — MILWAUKEE HEALTHCARE OPERATOR LLC

Table of content: (NPI 1700019387)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700019387 NPI number — MILWAUKEE HEALTHCARE OPERATOR LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MILWAUKEE HEALTHCARE OPERATOR LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
BIRCHWOOD HEALTHCARE AND REHABILITATION CENTER
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1700019387
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/30/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7400 NEW LA GRANGE RD
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
LOUISVILLE
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40222-4870
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
502-429-8062
Provider Business Mailing Address Fax Number:
502-429-0650

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9632 W APPLETON AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MILWAUKEE
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53225-3305
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
414-461-8850
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/28/2009

Additional Information

Authorized Official

Authorized Official Last Name:
ROGERS
Authorized Official First Name:
STACEY
Authorized Official Middle Name:
PAUL
Authorized Official Title or Position:
CHIEF FINANCIAL OFFICER
Authorized Official Telephone Number:
502-429-8062

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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