Provider Demographics
NPI:1588051429
Name:JEWISH HOME AND CARE CENTER, INC
Entity type:Organization
Organization Name:JEWISH HOME AND CARE CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BAO
Authorized Official - Middle Name:HER
Authorized Official - Last Name:XIONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-277-8859
Mailing Address - Street 1:1414 N PROSPECT AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53202-3018
Mailing Address - Country:US
Mailing Address - Phone:414-276-2627
Mailing Address - Fax:414-431-1940
Practice Address - Street 1:1410 N PROSPECT AVE
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53202-3062
Practice Address - Country:US
Practice Address - Phone:414-277-8859
Practice Address - Fax:414-431-1940
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JEWISH HOME & CARE CENTER, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-04-17
Last Update Date:2022-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI0009129261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care