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NPI Code Detail

MEDICARE: ELITE SENIOR LIVING - MILWAUKEE, LLC

MEDICARE: ELITE SENIOR LIVING - MILWAUKEE, 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 : 1912107715
Entity Type Code : Organization
Provider Name (Legal Business Name) : ELITE SENIOR LIVING - MILWAUKEE, LLC
Provider Business Mailing Address
First Line : 9350 W FOND DU LAC AVE
Second Line :
City : MILWAUKEE
State : WI
Zip : 53225-1714
Country : US
Telephone Number : 866-350-9320
Fax Number : 866-843-0885
Provider Business Practice Location Address
First Line : 9350 W FOND DU LAC AVE
Second Line :
City : MILWAUKEE
State : WI
Zip : 53225-1714
Country : US
Telephone Number : 866-350-9320
Fax Number : 866-843-0885
Authorized Official
Title or Position : MANAGING MEMBER
Name : MR. JONATHAN HERATY
Credential :
Telephone Number : 866-350-9320
Provider Enumeration Date : 07/19/2007
Last Update Date : 11/07/2007

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