Provider Demographics
NPI:1598027476
Name:KINDRED TRANSITIONAL CARE AND REHAB MILWAUKEE
Entity Type:Organization
Organization Name:KINDRED TRANSITIONAL CARE AND REHAB MILWAUKEE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST ASSISTANT
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:ADAM
Authorized Official - Last Name:FRAAZA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-281-7200
Mailing Address - Street 1:5700 W LAYTON AVE
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53220
Mailing Address - Country:US
Mailing Address - Phone:414-281-7200
Mailing Address - Fax:
Practice Address - Street 1:5700 W LAYTON AVE
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:WI
Practice Address - Zip Code:53220-4016
Practice Address - Country:US
Practice Address - Phone:414-281-7200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-15
Last Update Date:2012-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1758-019314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility