Provider Demographics
NPI:1598141335
Name:ST ANN CENTER FOR INTERGENERATIONAL CARE INC
Entity Type:Organization
Organization Name:ST ANN CENTER FOR INTERGENERATIONAL CARE INC
Other - Org Name:ST. ANN CENTER MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:TEMIDAYO
Authorized Official - Middle Name:I
Authorized Official - Last Name:AKANDE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-977-5004
Mailing Address - Street 1:2801 E MORGAN AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53207-3771
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2801 E MORGAN AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53207-3771
Practice Address - Country:US
Practice Address - Phone:414-977-5000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-04
Last Update Date:2020-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service