MEDICARE: LOUISE B., 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	3185	WI

Other Identifiers

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

General Provider Information

NPI Number	:	1386883502
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LOUISE B., LLC.

Provider Business Mailing Address
First Line	:	1633 W BENDER RD
Second Line	:
City	:	GLENDALE
State	:	WI
Zip	:	53209-3801
Country	:	US
Telephone Number	:	312-705-2000
Fax Number	:	317-245-2510

Provider Business Practice Location Address
First Line	:	1633 W BENDER RD
Second Line	:
City	:	GLENDALE
State	:	WI
Zip	:	53209-3801
Country	:	US
Telephone Number	:	312-705-2000
Fax Number	:	317-245-2510

Authorized Official
Title or Position	:	CONTROLLER
Name	:	MRS. CYNTHIA RENE ROTH
Credential	:
Telephone Number	:	317-557-1190

Provider Enumeration Date	:	02/11/2009
Last Update Date	:	02/11/2009

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Directions to “LOUISE B., LLC. ” Practice Location

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