Healthcare Provider Details

I. General information

NPI: 1679841787
Provider Name (Legal Business Name): SACRED HEART INSTITUTE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/03/2011
Last Update Date: 12/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2323 N LAKE DR
MILWAUKEE WI
53211-4508
US

IV. Provider business mailing address

2323 N LAKE DR
MILWAUKEE WI
53211-4508
US

V. Phone/Fax

Practice location:
  • Phone: 414-289-6714
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code283X00000X
TaxonomyRehabilitation Hospital
License Number
License Number State

VIII. Authorized Official

Name: MICHELLE BURESH
Title or Position: SLP
Credential:
Phone: 414-289-6714