Provider Demographics
NPI:1235179292
Name:WHEATON FRANCISCAN HEALTHCARE-MARIAN FRANCISCAN CENTER, INC
Entity Type:Organization
Organization Name:WHEATON FRANCISCAN HEALTHCARE-MARIAN FRANCISCAN CENTER, INC
Other - Org Name:MARIAN FRANCISCAN CENTER, INC DMERC
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:GRESHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-535-6907
Mailing Address - Street 1:9632 W APPLETON AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53225-3305
Mailing Address - Country:US
Mailing Address - Phone:414-461-8850
Mailing Address - Fax:
Practice Address - Street 1:9632 W APPLETON AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53225-3305
Practice Address - Country:US
Practice Address - Phone:414-461-8850
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-07
Last Update Date:2013-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI0356610001Medicare NSC