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Organization
ST. JOSEPH'S HOME OF OUR LADY OF MT CARMEL INC
Active
Organization
ST. JOSEPH'S HOME OF OUR LADY OF MT CARMEL INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SUSIE K EIDSOR (BUSINESS MANAGER)
(262) 925-8104
Entity
Organization
Contact information
Practice address
9244 29TH AVE, KENOSHA, WI 53143-6602
(262) 694-0080
(262) 925-8137
Mailing address
9244 29TH AVE, KENOSHA, WI 53143-6602
(262) 694-0080
(262) 925-8137
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
2332
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
20154500
—
WI
Enumeration date
10/21/2005
Last updated
08/11/2011
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