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Organization
EXTENDICARE HOMES, INC.
Active
Organization
EXTENDICARE HOMES, INC.
Active
Other names
Professional Care 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
404 WEST WILLOW ROAD, DALE, IN 47523
(812) 937-4489
(812) 937-7101
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
Enumeration date
11/17/2006
Last updated
08/22/2020
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