MEDICARE: GOOD HOPE MANOR-MILWAUKEE

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	310400000X	Assisted Living Facility		WI

General Provider Information

NPI Number	:	1316129448
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GOOD HOPE MANOR-MILWAUKEE

Provider Business Mailing Address
First Line	:	7060 NORTH 124TH STREET
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53224
Country	:	US
Telephone Number	:	414-358-1774
Fax Number	:

Provider Business Practice Location Address
First Line	:	7060 N 124TH ST
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53224-4206
Country	:	US
Telephone Number	:	414-358-1774
Fax Number	:

Authorized Official
Title or Position	:	OWNER/OPERATOR
Name	:	MRS. LINDA J WITZLIB
Credential	:
Telephone Number	:	414-358-1774

Provider Enumeration Date	:	11/30/2007
Last Update Date	:	11/30/2007

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