Healthcare Provider Details

I. General information

NPI: 1942077433
Provider Name (Legal Business Name): PARKERS MANOR OF CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2023
Last Update Date: 12/05/2023
Certification Date: 12/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4307 N 69TH ST
MILWAUKEE WI
53216-1126
US

IV. Provider business mailing address

6815 W CAPITOL DR STE 107
MILWAUKEE WI
53216-2056
US

V. Phone/Fax

Practice location:
  • Phone: 414-210-2308
  • Fax: 414-455-3777
Mailing address:
  • Phone: 414-210-2308
  • Fax: 414-455-3777

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: MAKALIA PARKER
Title or Position: OWNER
Credential:
Phone: 414-202-0378