Organization
WISCONSIN LUTHERAN CHILD & FAMILY SERVICES, INC
Active
Other names
Wisconsin Lutheran Care Center
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DAVID TANCK (ADMINISTRATOR)
(414) 353-5005
Entity
Organization
Contact information
Practice address
6800 N 76TH ST, MILWAUKEE, WI 53223-5002
(414) 353-5000
(414) 353-5506
Mailing address
6800 N 76TH ST, MILWAUKEE, WI 53223-5002
(414) 353-5000
(414) 353-5506
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
2179
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
20132300
—
WI
01
—
71-00024
EVERCARE PROVIDER NUMBER
WI
Enumeration date
02/09/2006
Last updated
08/22/2020
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