Healthcare Provider Details

I. General information

NPI: 1902804586
Provider Name (Legal Business Name): MILWAUKEE CATHOLIC HOME, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2005
Last Update Date: 11/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2330 N PROSPECT AVE
MILWAUKEE WI
53211-4455
US

IV. Provider business mailing address

2330 N PROSPECT AVE
MILWAUKEE WI
53211-4455
US

V. Phone/Fax

Practice location:
  • Phone: 414-220-4610
  • Fax: 414-220-8495
Mailing address:
  • Phone: 414-220-4610
  • Fax: 414-220-8495

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number3213
License Number StateWI

VIII. Authorized Official

Name: MS. ROHINI J. DESAI
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 414-220-8468