Organization
MILWAUKEE HEALTH CARE, LLC
Active
Other names
Wellspring of Milwaukee
Organization subpart
No
Provider details
NPI number
Authorized official
MR. WILLIAM A NICHOLSON (MANAGING MEMBER)
(978) 535-6700
Entity
Organization
Contact information
Practice address
9350 W FOND DU LAC AVE, MILWAUKEE, WI 53225-1714
(414) 438-4360
(414) 464-3622
Mailing address
2 BOURBON ST, WEST PEABODY EXECUTIVE CENTER, SUITE 200, PEABODY, MA 01960-1384
(978) 535-6700
(978) 535-6701
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
2821
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100033186
—
WI
01
—
52-5367
MEDICARE PROVIDER NUMBER
WI
Enumeration date
10/11/2012
Last updated
01/14/2014
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