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NPI Code Detail

MEDICARE: MARY JUDE HEALTH CARE, INC.

MEDICARE: MARY JUDE HEALTH CARE, 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 Facility2962WI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1902016090
Entity Type Code : Organization
Provider Name (Legal Business Name) : MARY JUDE HEALTH CARE, INC.
Provider Business Mailing Address
First Line : 9806 W LINCOLN AVE
Second Line :
City : WEST ALLIS
State : WI
Zip : 53227-2234
Country : US
Telephone Number : 414-543-5330
Fax Number :
Provider Business Practice Location Address
First Line : 9806 W LINCOLN AVE
Second Line :
City : WEST ALLIS
State : WI
Zip : 53227-2234
Country : US
Telephone Number : 414-543-5330
Fax Number :
Authorized Official
Title or Position : ADMINISTRATOR
Name : MICHAEL FRISBY
Credential :
Telephone Number : 414-543-5330
Provider Enumeration Date : 05/23/2007
Last Update Date : 08/22/2020

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