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General NPI Number Information
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NPI Number | 1518934264
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Entity Type | Organization
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Legal Business Name | METHODIST MANOR HEALTH CENTER, INC.
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Dates
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Enumeration Date | 03/01/2006
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 7300 W DEAN RD
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City | MILWAUKEE
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State | WI
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Zip | 53223-2637
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Country | US
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Telephone | 414-371-7381
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Fax | 414-371-7525
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Provider Business Mailing Address
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Address Line | 3023 S 84TH ST
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City | WEST ALLIS
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State | WI
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Zip | 53227-3703
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Country | US
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Telephone | 414-607-4100
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Fax | 414-607-4502
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Authorized Official
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Title or Position | PRESIDENT & CEO
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Name | MR. JAMES ENLUND
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Credential |
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Telephone | 414-607-4100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | 8439
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License Number State | WI
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