Healthcare Provider Details

I. General information

NPI: 1417058488
Provider Name (Legal Business Name): ORION MILWAUKEE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3216 W HIGHLAND BLVD
MILWAUKEE WI
53208-3252
US

IV. Provider business mailing address

1 EASTON OVAL SUITE 300
COLUMBUS OH
43219-6061
US

V. Phone/Fax

Practice location:
  • Phone: 414-344-6515
  • Fax:
Mailing address:
  • Phone: 614-416-2662
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number3162
License Number StateWI

VIII. Authorized Official

Name: KEITH JAMES YODER
Title or Position: CFO
Credential:
Phone: 614-416-2662