Organization
CAPITOL TERRACE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
VICKIE GAILLARD LPN (MEMBER)
(414) 915-7499
Entity
Organization
Contact information
Practice address
4019 N 87TH ST, MILWAUKEE, WI 53222-1708
(414) 915-7499
Mailing address
4480 N 85TH ST, MILWAUKEE, WI 53225-5108
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
—
—
Other
Enumeration date
04/04/2015
Last updated
05/27/2015
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