Organization
ST. ANN CENTER FOR INTERGENERATIONAL CARE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. LAURA K CHEREKLAABS RDH (DIRECTOR DENTAL PROGRAMS)
(414) 977-5000
Entity
Organization
Contact information
Practice address
2450 W NORTH AVE, MILWAUKEE, WI 53205
(414) 977-5000
Mailing address
2801 E MORGAN AVE, MILWAUKEE, WI 53207-3771
(414) 977-5000
Taxonomy
Speciality
Code
Description
License number
State
251K00000X
Public Health or Welfare Agency
Primary
5705-16
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1023140118
—
WI
05
—
1831499532
—
WI
05
—
1982075719
—
WI
Enumeration date
08/31/2015
Last updated
03/16/2016
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