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NPI Code Detail

MEDICARE: WISCONSIN LUTHERAN CHILD & FAMILY SERVICES, INC

MEDICARE: WISCONSIN LUTHERAN CHILD & FAMILY SERVICES, INC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1314000000XSkilled Nursing Facility2179WI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
271-00024OTHERWIEVERCARE PROVIDER NUMBER

General Provider Information

NPI Number : 1447223524
Entity Type Code : Organization
Provider Name (Legal Business Name) : WISCONSIN LUTHERAN CHILD & FAMILY SERVICES, INC
Provider Business Mailing Address
First Line : 6800 N 76TH ST
Second Line :
City : MILWAUKEE
State : WI
Zip : 53223-5002
Country : US
Telephone Number : 414-353-5000
Fax Number : 414-353-5506
Provider Business Practice Location Address
First Line : 6800 N 76TH ST
Second Line :
City : MILWAUKEE
State : WI
Zip : 53223-5002
Country : US
Telephone Number : 414-353-5000
Fax Number : 414-353-5506
Authorized Official
Title or Position : ADMINISTRATOR
Name : MR. DAVID TANCK
Credential :
Telephone Number : 414-353-5005
Provider Enumeration Date : 02/09/2006
Last Update Date : 08/22/2020

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