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NPI Code Detail

MEDICARE: METHODIST MANOR OF WAUKESHA, INC.

MEDICARE: METHODIST MANOR OF WAUKESHA, 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
1251G00000XCommunity Based Hospice Care Agency2002WI
2385H00000XRespite Care2002WI
3315D00000XInpatient Hospice2002WI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
12002OTHERWIFACILITY LICENSE NUMBER
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1952378648
Entity Type Code : Organization
Provider Name (Legal Business Name) : METHODIST MANOR OF WAUKESHA, INC.
Provider Business Mailing Address
First Line : 3023 S 84TH ST
Second Line :
City : WEST ALLIS
State : WI
Zip : 53227-3703
Country : US
Telephone Number : 414-607-4100
Fax Number : 414-607-4502
Provider Business Practice Location Address
First Line : 8526 W MILL RD
Second Line :
City : MILWAUKEE
State : WI
Zip : 53225-1934
Country : US
Telephone Number : 414-607-4710
Fax Number : 414-607-4711
Authorized Official
Title or Position : PRESIDENT & CEO
Name : MR. JAMES ENLUND
Credential :
Telephone Number : 414-607-4100
Provider Enumeration Date : 03/02/2006
Last Update Date : 04/08/2009

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