Provider Demographics
NPI:1235151937
Name:WHEATON FRANCISCAN HEALTHCARE-MARIAN FRANCISCAN CENTER,INC
Entity Type:Organization
Organization Name:WHEATON FRANCISCAN HEALTHCARE-MARIAN FRANCISCAN CENTER,INC
Other - Org Name:WHEATON FRANCISCAN HEALTHCARE-FRANCISCAN WOODS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:H
Authorized Official - Last Name:PIETTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:262-780-3100
Mailing Address - Street 1:19525 W NORTH AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53045-4107
Mailing Address - Country:US
Mailing Address - Phone:262-785-1114
Mailing Address - Fax:262-780-3805
Practice Address - Street 1:19525 W NORTH AVE
Practice Address - Street 2:
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53045-4107
Practice Address - Country:US
Practice Address - Phone:262-785-1114
Practice Address - Fax:262-780-3805
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-24
Last Update Date:2009-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2956314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI0356610003Medicare NSC