MEDICARE: FRANCISCAN VILLA OF SOUTH MILWAUKEE, INC.

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
2	314000000X	Skilled Nursing Facility	2185	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	:	1437156676
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FRANCISCAN VILLA OF SOUTH MILWAUKEE, INC.

Provider Business Mailing Address
First Line	:	3601 S CHICAGO AVE
Second Line	:
City	:	SOUTH MILWAUKEE
State	:	WI
Zip	:	53172-3708
Country	:	US
Telephone Number	:	414-764-4100
Fax Number	:	414-764-0706

Provider Business Practice Location Address
First Line	:	3601 S CHICAGO AVE
Second Line	:
City	:	SOUTH MILWAUKEE
State	:	WI
Zip	:	53172-3708
Country	:	US
Telephone Number	:	414-764-4100
Fax Number	:	414-764-0706

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MS. CHARLEAN ADAMS
Credential	:
Telephone Number	:	414-764-4100

Provider Enumeration Date	:	07/01/2005
Last Update Date	:	04/21/2015

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