Organization
ST. JOSEPH'S HOME OF OUR LADY OF MT CARMEL INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SUSIE K EIDSOR (BUSINESS MANAGER)
(262) 925-8104
Entity
Organization
Contact information
Practice address
9244 29TH AVE, KENOSHA, WI 53143-6602
(262) 694-0080
(262) 925-8137
Mailing address
9244 29TH AVE, KENOSHA, WI 53143-6602
(262) 694-0080
(262) 925-8137
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
2332
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
20154500
—
WI
Enumeration date
10/21/2005
Last updated
08/11/2011
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