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General NPI Number Information
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NPI Number | 1518941798
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Entity Type | Organization
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Legal Business Name | EASTCASTLE PLACE, INC.
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Dates
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Enumeration Date | 12/01/2005
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Last Update Date | 07/16/2019
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Provider Practice Location Address
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Address Line | 2429 E BRADFORD AVE
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City | MILWAUKEE
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State | WI
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Zip | 53211-4100
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Country | US
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Telephone | 414-963-6151
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Fax | 414-332-3440
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Provider Business Mailing Address
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Address Line | 2505 E BRADFORD AVE.
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City | MILWAUKEE
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State | WI
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Zip | 53211
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Country | US
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Telephone | 414-963-8481
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Fax | 414-332-3440
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Authorized Official
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Title or Position | CHAIRMAN
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Name | NANCY A O'DONNELL
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Credential |
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Telephone | 414-588-4828
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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 | 0069
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 1032
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License Number State | WI
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