Healthcare Provider Details

I. General information

NPI: 1790963411
Provider Name (Legal Business Name): LIFECARE HOSPITAL OF WISCONSIN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2008
Last Update Date: 02/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 GOLF RD
PEWAUKEE WI
53072-5590
US

IV. Provider business mailing address

2400 GOLF RD
PEWAUKEE WI
53072-5590
US

V. Phone/Fax

Practice location:
  • Phone: 262-524-2624
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code284300000X
TaxonomySpecial Hospital
License Number
License Number State

VIII. Authorized Official

Name: MS. CHRISTIE LYNNE SCHULTZ
Title or Position: DIETITIAN
Credential: RD, CD, CNSD
Phone: 262-524-2624