Healthcare Provider Details

I. General information

NPI: 1689076085
Provider Name (Legal Business Name): BKD BROOKDALE PLACE OF BROOKFIELD, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2014
Last Update Date: 07/02/2024
Certification Date: 07/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

660 WOELFEL RD
BROOKFIELD WI
53045-2927
US

IV. Provider business mailing address

660 WOELFEL RD
BROOKFIELD WI
53045-2927
US

V. Phone/Fax

Practice location:
  • Phone: 262-789-7499
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: ANNA MUNOZ
Title or Position: ASSISTANT SECRETARY
Credential:
Phone: 414-918-5000