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Organization
RIVERSHORE CLINIC
Active
Organization
RIVERSHORE CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LYNETTE FAMOUS LPN (LPN)
(262) 822-6751
Entity
Organization
Contact information
Practice address
3707 N. RICHARDS ST., MILWAUKEE HEALTH SERVICE, MILWAUKEE, WI 53212-1673
(414) 967-7006
Mailing address
3707 N RICHARDS ST, MILWAUKEE, WI 53212-1673
(414) 967-7006
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
306794
WI
Other
Enumeration date
04/03/2015
Last updated
04/03/2015
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