Provider Demographics
NPI:1235219148
Name:JANECZKO PROPERTIES LLC
Entity Type:Organization
Organization Name:JANECZKO PROPERTIES LLC
Other - Org Name:THE MILTON HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:
Authorized Official - Last Name:GAWEL
Authorized Official - Suffix:
Authorized Official - Credentials:LHFA
Authorized Official - Phone:574-233-0165
Mailing Address - Street 1:206 E MARION ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46601-1029
Mailing Address - Country:US
Mailing Address - Phone:574-233-0165
Mailing Address - Fax:574-237-9818
Practice Address - Street 1:206 E MARION ST
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46601-1029
Practice Address - Country:US
Practice Address - Phone:574-233-0165
Practice Address - Fax:574-237-9818
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-16
Last Update Date:2013-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN06 001141 1314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN155738Medicare Oscar/Certification