Provider Demographics
NPI:1407922776
Name:ST. CAMILLUS HEALTH CENTER, INC.
Entity type:Organization
Organization Name:ST. CAMILLUS HEALTH CENTER, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:MUNZEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-259-8355
Mailing Address - Street 1:10101 W WISCONSIN AVE
Mailing Address - Street 2:
Mailing Address - City:WAUWATOSA
Mailing Address - State:WI
Mailing Address - Zip Code:53226-4814
Mailing Address - Country:US
Mailing Address - Phone:414-258-2418
Mailing Address - Fax:414-259-4534
Practice Address - Street 1:10101 W WISCONSIN AVE
Practice Address - Street 2:
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53226-4814
Practice Address - Country:US
Practice Address - Phone:414-258-2418
Practice Address - Fax:414-259-4534
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-28
Last Update Date:2022-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI148251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41512800Medicaid
WI1407922776OtherUNITEDHEALTHCARE