Healthcare Provider Details

I. General information

NPI: 1306881594
Provider Name (Legal Business Name): MUSKEGO NURSING HOME INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2006
Last Update Date: 07/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

S. 77-W. 18690 JANESVILLE RD
MUSKEGO WI
53150
US

IV. Provider business mailing address

S. 77-W. 18690 JANESVILLE RD
MUSKEGO WI
53150
US

V. Phone/Fax

Practice location:
  • Phone: 262-679-0246
  • Fax: 262-679-9717
Mailing address:
  • Phone: 262-679-0246
  • Fax: 262-679-9717

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number1089
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number1089
License Number StateWI

VIII. Authorized Official

Name: MR. HAROLD M SWANTO JR.
Title or Position: OWNER/ADMIN/PRES.
Credential: N.H.A.
Phone: 262-679-0246