Provider Demographics
NPI:1437147980
Name:ST ANNES HOME FOR THE ELDERLY MILWAUKEE INC
Entity Type:Organization
Organization Name:ST ANNES HOME FOR THE ELDERLY MILWAUKEE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:CHWALA
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:920-206-4983
Mailing Address - Street 1:3800 N 92ND ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53222-2504
Mailing Address - Country:US
Mailing Address - Phone:414-463-7570
Mailing Address - Fax:414-463-2311
Practice Address - Street 1:3800 N 92ND ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53222-2504
Practice Address - Country:US
Practice Address - Phone:414-463-7570
Practice Address - Fax:414-463-2311
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-10
Last Update Date:2023-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI10362310400000X
WI2056314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI20154700Medicaid
WI20154700Medicaid