Organization
EXTENDICARE HOMES, INC.
Active
Other names
Willowcrest Care 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
3821 S CHICAGO AVE, SOUTH MILWAUKEE, WI 53172-3712
(414) 762-7336
(414) 762-5077
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
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
20003700
—
WI
Enumeration date
11/14/2006
Last updated
08/22/2020
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