# DYCORA TRANSITIONAL HEALTH - GREENDALE LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1538611579
- **Authorized official:** MARY HAWKINS (EXECUTIVE)
- **Authorized official phone:** (414) 421-0088

## Contact information

- **Practice address:** 5404 W LOOMIS RD, GREENDALE, WI 53129-1411
- **Practice address phone:** (414) 421-0088
- **Mailing address:** 5404 W LOOMIS RD, GREENDALE, WI 53129-1411
- **Mailing address phone:** (414) 421-0088

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | 3142 | WI | Yes |

## Other

- **Enumeration date:** 10/25/2016
- **Last updated:** 01/25/2018