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General NPI Number Information
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NPI Number | 1366690679
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Entity Type | Organization
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Legal Business Name | ST. CAMILLUS HEALTH CENTER, INC.
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Dates
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Enumeration Date | 08/29/2008
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Last Update Date | 12/05/2023
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Provider Practice Location Address
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Address Line | 10101 W WISCONSIN AVE
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City | WAUWATOSA
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State | WI
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Zip | 53226-4861
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Country | US
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Telephone | 414-258-2418
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Fax | 414-259-4534
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Provider Business Mailing Address
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Address Line | 10101 W WISCONSIN AVE
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City | WAUWATOSA
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State | WI
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Zip | 53226-4861
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Country | US
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Telephone | 414-258-2418
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Fax | 414-259-4534
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | ANN ONDREJICKA
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Credential | BSW
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Telephone | 414-258-2418
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251G00000X
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Taxonomy Name | Community Based Hospice Care Agency
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License Number | 2026
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License Number State | WI
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