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NPI Code Detail

MEDICARE: PROMINENT HEALTH CARE INC

MEDICARE: PROMINENT HEALTH CARE 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
1314000000XSkilled Nursing Facility3218WI

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 : 1801898127
Entity Type Code : Organization
Provider Name (Legal Business Name) : PROMINENT HEALTH CARE INC
Provider Business Mailing Address
First Line : 6263 N GREEN BAY AVE
Second Line :
City : GLENDALE
State : WI
Zip : 53209-3823
Country : US
Telephone Number : 414-351-0543
Fax Number : 414-351-7977
Provider Business Practice Location Address
First Line : 6263 N GREEN BAY AVE
Second Line :
City : GLENDALE
State : WI
Zip : 53209-3823
Country : US
Telephone Number : 414-351-0543
Fax Number : 414-351-7977
Authorized Official
Title or Position : ADMINSTRATOR
Name : MS. SUZANNE NAVIN
Credential :
Telephone Number : 414-351-0543
Provider Enumeration Date : 06/01/2005
Last Update Date : 08/22/2020

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Directions to “PROMINENT HEALTH CARE INC ” Practice Location

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