Healthcare Provider Details

I. General information

NPI: 1780285148
Provider Name (Legal Business Name): ARIA AT MITCHELL MANOR LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/03/2020
Last Update Date: 01/14/2021
Certification Date: 01/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5301 W LINCOLN AVE
WEST ALLIS WI
53219-1652
US

IV. Provider business mailing address

8150 CENTRAL PARK AVE
SKOKIE IL
60076-2974
US

V. Phone/Fax

Practice location:
  • Phone: 414-615-7100
  • Fax:
Mailing address:
  • Phone: 847-983-4860
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: DAVID MERZEL
Title or Position: CFO
Credential:
Phone: 847-983-4860