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NPI Code Detail

MEDICARE: METHODIST MANOR INC

MEDICARE: METHODIST MANOR 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
1310400000XAssisted Living FacilityNA-CBRFWI

Other Identifiers

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

General Provider Information

NPI Number : 1649247453
Entity Type Code : Organization
Provider Name (Legal Business Name) : METHODIST MANOR INC
Provider Business Mailing Address
First Line : 3023 S 84TH ST
Second Line :
City : WEST ALLIS
State : WI
Zip : 53227-3703
Country : US
Telephone Number : 414-607-4100
Fax Number :
Provider Business Practice Location Address
First Line : 3023 S 84TH ST
Second Line :
City : WEST ALLIS
State : WI
Zip : 53227-3703
Country : US
Telephone Number : 414-607-4100
Fax Number :
Authorized Official
Title or Position : PRESIDENT & CEO
Name : MR. JAMES ENLUND
Credential :
Telephone Number : 414-607-4101
Provider Enumeration Date : 03/01/2006
Last Update Date : 04/08/2009

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