MEDICARE: MARYS ADULT FAMILY SERVICES 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	DSL-2426	WI

General Provider Information

NPI Number	:	1427385038
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARYS ADULT FAMILY SERVICES LLC

Provider Business Mailing Address
First Line	:	2802 N 40TH ST
Second Line	:	SUITE 210
City	:	MILWAUKEE
State	:	WI
Zip	:	53210-1806
Country	:	US
Telephone Number	:	920-574-6672
Fax Number	:

Provider Business Practice Location Address
First Line	:	2802 N 40TH ST
Second Line	:	SUITE 210
City	:	MILWAUKEE
State	:	WI
Zip	:	53210-1806
Country	:	US
Telephone Number	:	920-574-6672
Fax Number	:

Authorized Official
Title or Position	:	NURSING DIRECTOR
Name	:	MS. CARRIE MROZINSKI
Credential	:	R.N, BSN
Telephone Number	:	262-327-2219

Provider Enumeration Date	:	11/03/2009
Last Update Date	:	11/03/2009

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