Healthcare Provider Details

I. General information

NPI: 1487600052
Provider Name (Legal Business Name): EXTENDICARE HEALTH FACILITIES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2006
Last Update Date: 04/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2730 W RAMSEY AVE
MILWAUKEE WI
53221-4814
US

IV. Provider business mailing address

2730 W RAMSEY AVE
MILWAUKEE WI
53221-4814
US

V. Phone/Fax

Practice location:
  • Phone: 414-282-2600
  • Fax:
Mailing address:
  • Phone: 414-282-2600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number3212
License Number StateWI

VIII. Authorized Official

Name: DONNA MAASSEN
Title or Position: DIRECTOR OF CORPORATE COMPLIANCE
Credential:
Phone: 414-908-8119