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NPI Code Detail

MEDICARE: NSH SHAWANO-MAPLE LLC

MEDICARE: NSH SHAWANO-MAPLE 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 Facility

General Provider Information

NPI Number : 1619510567
Entity Type Code : Organization
Provider Name (Legal Business Name) : NSH SHAWANO-MAPLE LLC
Provider Business Mailing Address
First Line : 5150 N PORT WASHINGTON RD STE 260
Second Line :
City : MILWAUKEE
State : WI
Zip : 53217-5470
Country : US
Telephone Number : 414-962-5250
Fax Number :
Provider Business Practice Location Address
First Line : N4231 STATE HIGHWAY 22
Second Line :
City : SHAWANO
State : WI
Zip : 54166-6130
Country : US
Telephone Number : 715-526-3158
Fax Number :
Authorized Official
Title or Position : MANAGING MEMBER
Name : JEFFREY HOEHN
Credential :
Telephone Number : 414-962-5250
Provider Enumeration Date : 10/23/2019
Last Update Date : 10/23/2019

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Directions to “NSH SHAWANO-MAPLE LLC ” Practice Location

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