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General NPI Number Information
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NPI Number | 1114923935
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Entity Type | Organization
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Legal Business Name | CLEMENT MANOR, INC.
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Dates
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Enumeration Date | 06/27/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3939 S 92ND ST
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City | GREENFIELD
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State | WI
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Zip | 53228-2140
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Country | US
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Telephone | 414-321-1800
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Fax | 414-546-7357
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Provider Business Mailing Address
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Address Line | 3939 S 92ND ST
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City | GREENFIELD
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State | WI
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Zip | 53228-2140
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Country | US
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Telephone | 414-321-1800
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Fax | 414-546-7357
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | DENNIS FERGER
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Credential |
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Telephone | 414-546-7330
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 2724
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License Number State | WI
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