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NPI Code Detail

MEDICARE: NSH DORCHESTER LLC

MEDICARE: NSH DORCHESTER LLC
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 Facility2681WI

General Provider Information

NPI Number : 1568914729
Entity Type Code : Organization
Provider Name (Legal Business Name) : NSH DORCHESTER LLC
Provider Business Mailing Address
First Line : 5150 N PORT WASHINGTON RD
Second Line : SUITE 260
City : GLENDALE
State : WI
Zip : 53217-5474
Country : US
Telephone Number : 414-962-5250
Fax Number : 414-962-5251
Provider Business Practice Location Address
First Line : 200 N 7TH AVE
Second Line :
City : STURGEON BAY
State : WI
Zip : 54235-1708
Country : US
Telephone Number : 920-743-6274
Fax Number : 920-743-5604
Authorized Official
Title or Position : MANAGING MEMBER
Name : JEFFREY CHARLES HOEHN
Credential :
Telephone Number : 414-962-5250
Provider Enumeration Date : 11/03/2016
Last Update Date : 12/29/2016

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Directions to “NSH DORCHESTER LLC ” Practice Location

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