Healthcare Provider Details

I. General information

NPI: 1316129448
Provider Name (Legal Business Name): GOOD HOPE MANOR-MILWAUKEE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2007
Last Update Date: 11/30/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7060 N 124TH ST
MILWAUKEE WI
53224-4206
US

IV. Provider business mailing address

7060 NORTH 124TH STREET
MILWAUKEE WI
53224
US

V. Phone/Fax

Practice location:
  • Phone: 414-358-1774
  • Fax:
Mailing address:
  • Phone: 414-358-1774
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MRS. LINDA J WITZLIB
Title or Position: OWNER/OPERATOR
Credential:
Phone: 414-358-1774