Healthcare Provider Details

I. General information

NPI: 1053426874
Provider Name (Legal Business Name): ST. CLARE TERRACE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3553 S 41ST ST
MILWAUKEE WI
53221-1024
US

IV. Provider business mailing address

3553 S 41ST ST
MILWAUKEE WI
53221-1024
US

V. Phone/Fax

Practice location:
  • Phone: 414-649-0730
  • Fax: 414-649-0740
Mailing address:
  • Phone: 414-649-0730
  • Fax: 414-649-0740

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number0010944
License Number StateWI

VIII. Authorized Official

Name: DENNIS FERGER
Title or Position: MANAGEMENT REPRESENTATIVE
Credential:
Phone: 414-546-7330