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Organization
EXTENDICARE HOMES, INC.
Active
Organization
EXTENDICARE HOMES, INC.
Active
Other names
Heritage Nursing And Rehabilitation Center
Organization subpart
No
Provider details
NPI number
Authorized official
DONNA JO MAASSEN (DIRECTOR OF COMPLIANCE)
(414) 908-8119
Entity
Organization
Contact information
Practice address
1119 N WISCONSIN ST, PORT WASHINGTON, WI 53074-1209
(262) 284-5892
(262) 284-1612
Mailing address
111 W MICHIGAN ST, MILWAUKEE, WI 53203-2903
(414) 908-8119
(414) 908-7105
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
20182700
—
WI
Enumeration date
11/13/2006
Last updated
04/07/2008
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