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NPI Code Detail

MEDICARE: MILWAUKEE HEALTH CARE, LLC

MEDICARE: MILWAUKEE HEALTH CARE, 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 Facility2821WI

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
152-5367OTHERWIMEDICARE PROVIDER NUMBER

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1366794562
Entity Type Code : Organization
Provider Name (Legal Business Name) : MILWAUKEE HEALTH CARE, LLC
Provider Business Mailing Address
First Line : 2 BOURBON ST
Second Line : WEST PEABODY EXECUTIVE CENTER, SUITE 200
City : PEABODY
State : MA
Zip : 01960-1384
Country : US
Telephone Number : 978-535-6700
Fax Number : 978-535-6701
Provider Business Practice Location Address
First Line : 9350 W FOND DU LAC AVE
Second Line :
City : MILWAUKEE
State : WI
Zip : 53225-1714
Country : US
Telephone Number : 414-438-4360
Fax Number : 414-464-3622
Authorized Official
Title or Position : MANAGING MEMBER
Name : MR. WILLIAM A NICHOLSON
Credential :
Telephone Number : 978-535-6700
Provider Enumeration Date : 10/11/2012
Last Update Date : 01/14/2014

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Directions to “MILWAUKEE HEALTH CARE, LLC ” Practice Location

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