Provider Demographics
NPI:1609823400
Name:WHEATON FRANCISCAN HEALTHCARE - MARIAN FRANCISCAN CENTER, INC.
Entity Type:Organization
Organization Name:WHEATON FRANCISCAN HEALTHCARE - MARIAN FRANCISCAN CENTER, INC.
Other - Org Name:MARIAN FRANCISCAN CENTER, INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT - CONTINUING CARE AND ALL
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:GRESHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-535-6907
Mailing Address - Street 1:9632 W APPLETON AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53225-3305
Mailing Address - Country:US
Mailing Address - Phone:414-461-8850
Mailing Address - Fax:
Practice Address - Street 1:9632 W APPLETON AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53225-3305
Practice Address - Country:US
Practice Address - Phone:414-461-8850
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-27
Last Update Date:2009-11-13
Deactivation Date:2008-12-29
Deactivation Code:
Reactivation Date:2009-01-07
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI20162900Medicaid
WI525399Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER