Healthcare Provider Details

I. General information

NPI: 1629245618
Provider Name (Legal Business Name): AMERICAN BAPTIST HOMES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2008
Last Update Date: 05/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

S77W12929 MCSHANE DR
MUSKEGO WI
53150-4052
US

IV. Provider business mailing address

S77W12929 MCSHANE DR
MUSKEGO WI
53150-4052
US

V. Phone/Fax

Practice location:
  • Phone: 414-525-0100
  • Fax:
Mailing address:
  • Phone: 414-525-0100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number3147-026
License Number StateWI

VIII. Authorized Official

Name: MRS. SUE DAVIS
Title or Position: BUSINESS OFFICE MANAGER
Credential:
Phone: 414-525-2104