MEDICARE: JEWISH HOME AND CARE CENTER, 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	261QA0600X	Adult Day Care Clinic/Center	0009129	WI

General Provider Information

NPI Number	:	1588051429
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JEWISH HOME AND CARE CENTER, INC

Provider Business Mailing Address
First Line	:	1414 N PROSPECT AVE
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53202-3018
Country	:	US
Telephone Number	:	414-276-2627
Fax Number	:	414-431-1940

Provider Business Practice Location Address
First Line	:	1410 N PROSPECT AVE
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53202-3062
Country	:	US
Telephone Number	:	414-277-8859
Fax Number	:	414-431-1940

Authorized Official
Title or Position	:	BILLING MANAGER
Name	:	MRS. BAO HER XIONG
Credential	:
Telephone Number	:	414-277-8859

Provider Enumeration Date	:	04/17/2015
Last Update Date	:	09/27/2022

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