Provider Demographics
NPI:1306843875
Name:MILLWAY HEALTHCARE LLC
Entity Type:Organization
Organization Name:MILLWAY HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF REIMBURSEMENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:CAROL
Authorized Official - Last Name:ROOP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:863-324-4739
Mailing Address - Street 1:8534 W MILL RD
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53225-1934
Mailing Address - Country:US
Mailing Address - Phone:414-353-2300
Mailing Address - Fax:414-353-2727
Practice Address - Street 1:8534 W MILL RD
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53225-1934
Practice Address - Country:US
Practice Address - Phone:414-353-2300
Practice Address - Fax:414-353-2727
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-30
Last Update Date:2008-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3231314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI5048560001OtherDME
WI20180200Medicaid
WI525601Medicare ID - Type Unspecified