Healthcare Provider Details

I. General information

NPI: 1669015517
Provider Name (Legal Business Name): NSH WILLIAMS BAY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2019
Last Update Date: 10/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

146 CLOVER ST
WILLIAMS BAY WI
53191-9779
US

IV. Provider business mailing address

5150 N PORT WASHINGTON RD STE 260
MILWAUKEE WI
53217-5470
US

V. Phone/Fax

Practice location:
  • Phone: 262-245-6400
  • Fax:
Mailing address:
  • Phone: 414-962-5250
  • 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: JEFFREY HOEHN
Title or Position: MANAGING MEMBER
Credential:
Phone: 414-962-5250