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General NPI Number Information
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NPI Number | 1902016090
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Entity Type | Organization
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Legal Business Name | MARY JUDE HEALTH CARE, INC.
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Dates
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Enumeration Date | 05/23/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 9806 W LINCOLN AVE
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City | WEST ALLIS
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State | WI
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Zip | 53227-2234
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Country | US
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Telephone | 414-543-5330
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Fax |
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Provider Business Mailing Address
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Address Line | 9806 W LINCOLN AVE
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City | WEST ALLIS
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State | WI
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Zip | 53227-2234
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Country | US
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Telephone | 414-543-5330
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MICHAEL FRISBY
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Credential |
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Telephone | 414-543-5330
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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 | 2962
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License Number State | WI
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