Healthcare Provider Details

I. General information

NPI: 1265965974
Provider Name (Legal Business Name): NSH GREEN BAY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2017
Last Update Date: 12/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1640 SHAWANO AVE
GREEN BAY WI
54303-3214
US

IV. Provider business mailing address

5150 N PORT WASHINGTON RD SUITE 260
MILWAUKEE WI
53217-5474
US

V. Phone/Fax

Practice location:
  • Phone: 920-499-5177
  • Fax: 920-499-6035
Mailing address:
  • Phone: 414-962-5250
  • Fax: 414-962-5259

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: JEFFREY C HOEHN
Title or Position: MANAGING MEMBER
Credential:
Phone: 414-962-5250