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General NPI Number Information
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NPI Number | 1598766784
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Entity Type | Organization
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Legal Business Name | SISTERS OF CHARITY OF OUR LADY MOTHER OF THE CHURCH
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Dates
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Enumeration Date | 08/10/2005
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Last Update Date | 10/14/2025
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Provider Practice Location Address
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Address Line | 109 S ATWOOD AVE
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City | JANESVILLE
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State | WI
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Zip | 53545-4098
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Country | US
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Telephone | 608-752-6709
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Fax |
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Provider Business Mailing Address
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Address Line | 1045 HILL ST
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City | WATERTOWN
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State | WI
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Zip | 53098-3015
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Country | US
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Telephone | 920-206-4983
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Fax | 920-261-4840
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Authorized Official
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Title or Position | CFO
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Name | MS. JULIE MARKS
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Credential |
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Telephone | 920-206-4983
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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 | 0624
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License Number State | WI
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