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NPI Code Detail

MEDICARE: GARDEN VIEW PLATINUM LLC

MEDICARE: GARDEN VIEW PLATINUM 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
1310400000XAssisted Living FacilityWI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
10012911OTHERWIWISCONSIN DHS

General Provider Information

NPI Number : 1124341938
Entity Type Code : Organization
Provider Name (Legal Business Name) : GARDEN VIEW PLATINUM LLC
Provider Business Mailing Address
First Line : 2448 S 102ND ST STE 305
Second Line :
City : WEST ALLIS
State : WI
Zip : 53227-2141
Country : US
Telephone Number : 414-940-6608
Fax Number : 262-364-2524
Provider Business Practice Location Address
First Line : 8526 W MILL RD
Second Line :
City : MILWAUKEE
State : WI
Zip : 53225-1934
Country : US
Telephone Number : 414-358-0407
Fax Number : 414-358-0019
Authorized Official
Title or Position : MANAGING DIRECTOR
Name : JOHN TERESINSKI
Credential :
Telephone Number : 414-940-6608
Provider Enumeration Date : 03/08/2010
Last Update Date : 04/27/2020

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Directions to “GARDEN VIEW PLATINUM LLC ” Practice Location

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