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NPI Code Detail

MEDICARE: EXTENDICARE HOMES, INC.

MEDICARE: EXTENDICARE HOMES, 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 Facility

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 : 1922179597
Entity Type Code : Organization
Provider Name (Legal Business Name) : EXTENDICARE HOMES, INC.
Provider Business Mailing Address
First Line : 111 W MICHIGAN ST
Second Line :
City : MILWAUKEE
State : WI
Zip : 53203-2903
Country : US
Telephone Number : 414-908-8119
Fax Number : 414-908-7105
Provider Business Practice Location Address
First Line : 8633 32ND AVE
Second Line :
City : KENOSHA
State : WI
Zip : 53142-5187
Country : US
Telephone Number : 262-694-8300
Fax Number : 262-694-3622
Authorized Official
Title or Position : DIRECTOR OF COMPLIANCE
Name : DONNA JO MAASSEN
Credential :
Telephone Number : 414-908-8119
Provider Enumeration Date : 11/13/2006
Last Update Date : 04/11/2008

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Directions to “EXTENDICARE HOMES, INC. ” Practice Location

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