1700998697 NPI number — HOLY FAMILY MEMORIAL INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700998697 NPI number — HOLY FAMILY MEMORIAL INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HOLY FAMILY MEMORIAL INC
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:
FROEDTERT HOLY FAMILY MEMORIAL HOSPITAL
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:
1700998697
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/13/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
N74W12501 LEATHERWOOD CT STE 103
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MENOMONEE FALLS
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53051-4490
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
414-777-0417
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2300 WESTERN AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MANITOWOC
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54220-3712
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
920-320-2011
Provider Business Practice Location Address Fax Number:
920-320-3500
Provider Enumeration Date:
08/31/2006

Additional Information

Authorized Official

Authorized Official Last Name:
VEESER
Authorized Official First Name:
THOMAS
Authorized Official Middle Name:
Authorized Official Title or Position:
CNO
Authorized Official Telephone Number:
920-320-2730

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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