Healthcare Provider Details

I. General information

NPI: 1457672081
Provider Name (Legal Business Name): MILLWAY CARE AND REHABILITATION, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2010
Last Update Date: 06/30/2010
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:
Mailing address:
  • Phone: 414-353-2300
  • Fax:

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: DAWN M MARSH
Title or Position: VP
Credential:
Phone: 608-225-2516