Healthcare Provider Details

I. General information

NPI: 1740543545
Provider Name (Legal Business Name): KINDRED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2012
Last Update Date: 06/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5677 N ARGYLE AVE
GLENDALE WI
53209-4359
US

IV. Provider business mailing address

5677 N ARGYLE AVE
GLENDALE WI
53209-4359
US

V. Phone/Fax

Practice location:
  • Phone: 414-380-3434
  • Fax:
Mailing address:
  • Phone: 414-380-3434
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number4450-26
License Number StateWI

VIII. Authorized Official

Name: MS. JAMIE M SCHAAP
Title or Position: PROGRAM DIRECTOR
Credential: MSOTR
Phone: 414-380-3434