Provider Demographics
NPI:1639413958
Name:JANIE'S PLACE
Entity Type:Organization
Organization Name:JANIE'S PLACE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHANA
Authorized Official - Middle Name:S
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-943-8400
Mailing Address - Street 1:8540 W APPLETON AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53225-4283
Mailing Address - Country:US
Mailing Address - Phone:414-943-8400
Mailing Address - Fax:414-763-9273
Practice Address - Street 1:8540 W APPLETON AVE APT 1
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53225-4283
Practice Address - Country:US
Practice Address - Phone:414-943-8400
Practice Address - Fax:414-763-9273
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-27
Last Update Date:2012-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI0013321310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility