Provider Demographics
NPI:1750594867
Name:ST. FRANCIS CHILDREN'S CENTER
Entity type:Organization
Organization Name:ST. FRANCIS CHILDREN'S CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:WITKOV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-351-0450
Mailing Address - Street 1:6700 N PORT WASHINGTON RD
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53217-3919
Mailing Address - Country:US
Mailing Address - Phone:414-351-8851
Mailing Address - Fax:414-351-8846
Practice Address - Street 1:6700 N PORT WASHINGTON RD
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53217-3919
Practice Address - Country:US
Practice Address - Phone:414-351-8851
Practice Address - Fax:414-351-8846
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-07
Last Update Date:2024-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41224400Medicaid