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General NPI Number Information
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NPI Number | 1558434118
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Entity Type | Organization
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Legal Business Name | EXTENDICARE HOMES, INC.
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Dates
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Enumeration Date | 11/15/2006
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Last Update Date | 03/18/2009
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Provider Practice Location Address
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Address Line | 1267 S HILL RD
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City | ERIE
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State | PA
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Zip | 16509-4831
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Country | US
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Telephone | 814-864-4081
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Fax | 814-868-0514
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Provider Business Mailing Address
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Address Line | 111 W MICHIGAN ST
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City | MILWAUKEE
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State | WI
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Zip | 53203-2903
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Country | US
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Telephone | 414-908-8119
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Fax | 414-908-7105
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Authorized Official
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Title or Position | DIRECTOR OF COMPLIANCE
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Name | DONNA JO MAASSEN
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Credential |
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Telephone | 414-908-8119
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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 |
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License Number State |
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