Healthcare Provider Details

I. General information

NPI: 1255734067
Provider Name (Legal Business Name): JB MILWAUKEE HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2014
Last Update Date: 10/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6800 N 76TH ST
MILWAUKEE WI
53223-5002
US

IV. Provider business mailing address

6800 N 76TH ST
MILWAUKEE WI
53223-5002
US

V. Phone/Fax

Practice location:
  • Phone: 414-353-5000
  • Fax: 414-353-1487
Mailing address:
  • Phone: 414-353-5000
  • Fax: 414-353-1487

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number StateWI

VIII. Authorized Official

Name: MR. BRIAN LEVINSON
Title or Position: MANAGER
Credential:
Phone: 847-329-4100