Healthcare Provider Details

I. General information

NPI: 1588051429
Provider Name (Legal Business Name): JEWISH HOME AND CARE CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2015
Last Update Date: 09/27/2022
Certification Date: 09/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1410 N PROSPECT AVE
MILWAUKEE WI
53202-3062
US

IV. Provider business mailing address

1414 N PROSPECT AVE
MILWAUKEE WI
53202-3018
US

V. Phone/Fax

Practice location:
  • Phone: 414-277-8859
  • Fax: 414-431-1940
Mailing address:
  • Phone: 414-276-2627
  • Fax: 414-431-1940

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number0009129
License Number StateWI

VIII. Authorized Official

Name: MRS. BAO HER XIONG
Title or Position: BILLING MANAGER
Credential:
Phone: 414-277-8859