Healthcare Provider Details

I. General information

NPI: 1316908908
Provider Name (Legal Business Name): MJCARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/31/2006
Last Update Date: 09/22/2021
Certification Date: 09/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2330 N PROSPECT AVE
MILWAUKEE WI
53211-4455
US

IV. Provider business mailing address

2725 S MOORLAND RD STE 301
NEW BERLIN WI
53151-3720
US

V. Phone/Fax

Practice location:
  • Phone: 414-220-4610
  • Fax:
Mailing address:
  • Phone: 414-329-2500
  • Fax: 414-329-2501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JANE BEISSER
Title or Position: VICE PRESIDENT
Credential:
Phone: 414-329-2429