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General NPI Number Information
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NPI Number | 1568438265
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Entity Type | Organization
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Legal Business Name | M.A.T.C.H.
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Dates
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Enumeration Date | 02/23/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2902 N 1ST ST
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City | MILWAUKEE
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State | WI
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Zip | 53212-2406
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Country | US
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Telephone | 414-372-0739
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Fax |
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Provider Business Mailing Address
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Address Line | 2902 N 1ST ST
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City | MILWAUKEE
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State | WI
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Zip | 53212-2406
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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 | ONWER
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Name | MS. MERRY KYLES
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Credential |
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Telephone | 414-372-0739
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3104A0630X
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Taxonomy Name | Assisted Living Facility (Behavioral Disturbances)
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License Number |
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License Number State | WI
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