Provider Demographics
NPI:1144796988
Name:ST ANN CENTER FOR INTERGENERATIONAL CARE INC
Entity Type:Organization
Organization Name:ST ANN CENTER FOR INTERGENERATIONAL CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:TEMIDAYO
Authorized Official - Middle Name:I
Authorized Official - Last Name:AKANDE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-977-5004
Mailing Address - Street 1:2450 W NORTH AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53205-1001
Mailing Address - Country:US
Mailing Address - Phone:414-210-2450
Mailing Address - Fax:414-210-2434
Practice Address - Street 1:2450 W NORTH AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53205-1001
Practice Address - Country:US
Practice Address - Phone:414-210-2450
Practice Address - Fax:414-210-2434
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ST ANN CENTER FOR INTERGENERATIONAL CARE INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-10-19
Last Update Date:2018-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service