Healthcare Provider Details

I. General information

NPI: 1659848505
Provider Name (Legal Business Name): HOLY FAMILY MEMORIAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/30/2018
Last Update Date: 06/29/2026
Certification Date: 04/14/2025
Deactivation Date: 05/23/2025
Reactivation Date: 06/29/2026

III. Provider practice location address

2300 WESTERN AVE
MANITOWOC WI
54220-3712
US

IV. Provider business mailing address

N74W12501 LEATHERWOOD CT
MENOMONEE FALLS WI
53051-4490
US

V. Phone/Fax

Practice location:
  • Phone: 952-653-2565
  • Fax: 952-653-2540
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: THOMAS VEESER
Title or Position: CNO
Credential:
Phone: 929-320-2730