Organization
MIDWAY MANOR CORP.
Active
Other names
Clairidge House
Organization subpart
No
Provider details
NPI number
Authorized official
DAVID EGAN (ADMINISTRATOR)
(262) 656-7500
Entity
Organization
Contact information
Practice address
1519 60TH ST, KENOSHA, WI 53140-3954
(262) 656-7500
Mailing address
1519 60TH ST, KENOSHA, WI 53140-3954
(262) 656-7500
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
2823
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
20117200
—
WI
Enumeration date
05/23/2007
Last updated
08/22/2020
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