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NPI Code Detail

MEDICARE: DYCORA TRANSITIONAL HEALTH - MILWAUKEE LLC

MEDICARE: DYCORA TRANSITIONAL HEALTH - MILWAUKEE 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
1314000000XSkilled Nursing Facility3178WI

General Provider Information

NPI Number : 1245781418
Entity Type Code : Organization
Provider Name (Legal Business Name) : DYCORA TRANSITIONAL HEALTH - MILWAUKEE LLC
Provider Business Mailing Address
First Line : 1616 W BENDER RD
Second Line :
City : GLENDALE
State : WI
Zip : 53209-3802
Country : US
Telephone Number : 414-228-8700
Fax Number :
Provider Business Practice Location Address
First Line : 1616 W BENDER RD
Second Line :
City : GLENDALE
State : WI
Zip : 53209-3802
Country : US
Telephone Number : 414-228-8700
Fax Number :
Authorized Official
Title or Position : EXECUTIVE
Name : MARY HAWKINS
Credential :
Telephone Number : 414-228-8700
Provider Enumeration Date : 10/21/2016
Last Update Date : 01/25/2018

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Directions to “DYCORA TRANSITIONAL HEALTH - MILWAUKEE LLC ” Practice Location

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