Organization
MANOR CARE OF PEWAUKEE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JAIME MARIE TROEDEL (PTA)
(262) 253-0933
Entity
Organization
Contact information
Practice address
N26W23977 WATERTOWN RD, WAUKESHA, WI 53188-1006
(262) 523-0933
Mailing address
N27W23977 WATERTOWN RD, WAUKESHA, WI 53188-1006
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
758-19
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
20199600
—
WI
Enumeration date
04/30/2009
Last updated
04/30/2009
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