Provider Demographics
NPI:1508105214
Name:THE VILLA AT MILLWAY, LLC
Entity Type:Organization
Organization Name:THE VILLA AT MILLWAY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:
Authorized Official - Last Name:ISRAEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-692-1152
Mailing Address - Street 1:6400 SHAFER CT
Mailing Address - Street 2:SUITE 700
Mailing Address - City:ROSEMONT
Mailing Address - State:IL
Mailing Address - Zip Code:60018-4914
Mailing Address - Country:US
Mailing Address - Phone:847-692-1152
Mailing Address - Fax:847-692-1001
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:414-358-2090
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-01
Last Update Date:2013-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI525707Medicare PIN