Provider Demographics
NPI:1437156676
Name:FRANCISCAN VILLA OF SOUTH MILWAUKEE, INC.
Entity Type:Organization
Organization Name:FRANCISCAN VILLA OF SOUTH MILWAUKEE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:CHARLEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:ADAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-764-4100
Mailing Address - Street 1:3601 S CHICAGO AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53172-3708
Mailing Address - Country:US
Mailing Address - Phone:414-764-4100
Mailing Address - Fax:414-764-0706
Practice Address - Street 1:3601 S CHICAGO AVE
Practice Address - Street 2:
Practice Address - City:SOUTH MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53172-3708
Practice Address - Country:US
Practice Address - Phone:414-764-4100
Practice Address - Fax:414-764-0706
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-01
Last Update Date:2015-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
310400000X
WI2185314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI20152200Medicaid
WI20152200Medicaid