MEDICARE: NSH ELLSWORTH LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility

General Provider Information

NPI Number	:	1063055986
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NSH ELLSWORTH LLC

Provider Business Mailing Address
First Line	:	5150 N PORT WASHINGTON RD
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53217-5474
Country	:	US
Telephone Number	:	414-962-5250
Fax Number	:

Provider Business Practice Location Address
First Line	:	403 N MAPLE ST
Second Line	:
City	:	ELLSWORTH
State	:	WI
Zip	:	54011-9037
Country	:	US
Telephone Number	:	715-273-5821
Fax Number	:	715-273-6182

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	JEFFREY HOEHN
Credential	:
Telephone Number	:	414-962-5250

Provider Enumeration Date	:	10/23/2019
Last Update Date	:	10/23/2019

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