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General NPI Number Information
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NPI Number | 1245625482
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Entity Type | Organization
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Legal Business Name | CAPITOL TERRACE LLC
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Dates
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Enumeration Date | 04/04/2015
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Last Update Date | 05/27/2015
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Provider Practice Location Address
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Address Line | 4019 N 87TH ST
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City | MILWAUKEE
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State | WI
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Zip | 53222-1708
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Country | US
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Telephone | 414-915-7499
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Fax |
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Provider Business Mailing Address
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Address Line | 4480 N 85TH ST
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City | MILWAUKEE
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State | WI
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Zip | 53225-5108
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | VICKIE GAILLARD
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Credential | LPN
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Telephone | 414-915-7499
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number |
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License Number State |
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