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General NPI Number Information
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NPI Number | 1235355967
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Entity Type | Organization
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Legal Business Name | DOMINICAN SISTERS CORP. ST ANN REST HOME
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Dates
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Enumeration Date | 04/18/2007
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Last Update Date | 06/25/2008
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Provider Practice Location Address
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Address Line | 2020 S MUSKEGO AVE
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City | MILWAUKEE
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State | WI
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Zip | 53204-3622
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Country | US
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Telephone | 414-383-2630
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Fax | 414-383-0305
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Provider Business Mailing Address
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Address Line | 2020 S MUSKEGO AVE
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City | MILWAUKEE
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State | WI
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Zip | 53204-3622
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Country | US
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Telephone | 414-383-2630
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Fax | 414-383-0305
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | KATARZYNA ANDRZEJEWSKA
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Credential | NHA
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Telephone | 414-383-2630
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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 | 0245
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License Number State | WI
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