Provider Demographics
NPI:1801892997
Name:SISTER SERVANTS OF CHRIST THE KING INC
Entity type:Organization
Organization Name:SISTER SERVANTS OF CHRIST THE KING INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:MABRY
Authorized Official - Suffix:
Authorized Official - Credentials:NHA
Authorized Official - Phone:920-753-3211
Mailing Address - Street 1:N8114 COUNTY RD WW
Mailing Address - Street 2:
Mailing Address - City:MOUNT CALVARY
Mailing Address - State:WI
Mailing Address - Zip Code:53057-9607
Mailing Address - Country:US
Mailing Address - Phone:920-753-3211
Mailing Address - Fax:920-753-3100
Practice Address - Street 1:N8114 COUNTY ROAD WW
Practice Address - Street 2:
Practice Address - City:MOUNT CALVARY
Practice Address - State:WI
Practice Address - Zip Code:53057-9525
Practice Address - Country:US
Practice Address - Phone:920-753-3211
Practice Address - Fax:920-753-3100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-23
Last Update Date:2022-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1165314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI20158200Medicaid
WI20158200Medicaid