Provider Demographics
NPI:1134364664
Name:WHEATON FRANCISCAN HEALTHCARE MARIAN FRANCISCAN CENTER
Entity type:Organization
Organization Name:WHEATON FRANCISCAN HEALTHCARE MARIAN FRANCISCAN CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REHAB MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KRISTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:WIEDOWER
Authorized Official - Suffix:
Authorized Official - Credentials:MPT
Authorized Official - Phone:414-535-6750
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:414-535-6750
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:414-535-6750
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-12
Last Update Date:2008-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40342700Medicaid