Healthcare Provider Details

I. General information

NPI: 1306843875
Provider Name (Legal Business Name): MILLWAY HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2005
Last Update Date: 01/31/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8534 W MILL RD
MILWAUKEE WI
53225-1934
US

IV. Provider business mailing address

8534 W MILL RD
MILWAUKEE WI
53225-1934
US

V. Phone/Fax

Practice location:
  • Phone: 414-353-2300
  • Fax: 414-353-2727
Mailing address:
  • Phone: 414-353-2300
  • Fax: 414-353-2727

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number3231
License Number StateWI

VIII. Authorized Official

Name: MRS. CHRISTINA CAROL ROOP
Title or Position: DIRECTOR OF REIMBURSEMENT
Credential:
Phone: 863-324-4739