Provider Demographics
NPI:1518941798
Name:EASTCASTLE PLACE, INC.
Entity Type:Organization
Organization Name:EASTCASTLE PLACE, INC.
Other - Org Name:EASTCASTLE PLACE BRADFORD TERRACE CONVALESCENT CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHAIRMAN
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:A
Authorized Official - Last Name:O'DONNELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-588-4828
Mailing Address - Street 1:2505 E BRADFORD AVE.
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53211
Mailing Address - Country:US
Mailing Address - Phone:414-963-8481
Mailing Address - Fax:414-332-3440
Practice Address - Street 1:2429 E BRADFORD AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53211-4100
Practice Address - Country:US
Practice Address - Phone:414-963-6151
Practice Address - Fax:414-332-3440
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-01
Last Update Date:2019-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI0069310400000X
WI1032314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
525085Medicare Oscar/Certification