Provider Demographics
NPI:1912107715
Name:ELITE SENIOR LIVING - MILWAUKEE, LLC
Entity Type:Organization
Organization Name:ELITE SENIOR LIVING - MILWAUKEE, LLC
Other - Org Name:BEL AIR CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:HERATY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:866-350-9320
Mailing Address - Street 1:9350 W FOND DU LAC AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53225-1714
Mailing Address - Country:US
Mailing Address - Phone:866-350-9320
Mailing Address - Fax:866-843-0885
Practice Address - Street 1:9350 W FOND DU LAC AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53225-1714
Practice Address - Country:US
Practice Address - Phone:866-350-9320
Practice Address - Fax:866-843-0885
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-19
Last Update Date:2007-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility