Provider Demographics
NPI:1932197654
Name:AMERICAN BAPTIST HOMES OF THE MIDWEST
Entity type:Organization
Organization Name:AMERICAN BAPTIST HOMES OF THE MIDWEST
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF RESIDENT RECEIVABLES
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:R
Authorized Official - Last Name:KOTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-639-3008
Mailing Address - Street 1:S77W12929 MCSHANE DR
Mailing Address - Street 2:
Mailing Address - City:MUSKEGO
Mailing Address - State:WI
Mailing Address - Zip Code:53150-4039
Mailing Address - Country:US
Mailing Address - Phone:414-529-0100
Mailing Address - Fax:414-529-0537
Practice Address - Street 1:S77W12929 MCSHANE DR
Practice Address - Street 2:
Practice Address - City:MUSKEGO
Practice Address - State:WI
Practice Address - Zip Code:53150-4039
Practice Address - Country:US
Practice Address - Phone:414-529-0100
Practice Address - Fax:414-529-0537
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-06
Last Update Date:2019-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI20113200Medicaid
WI525279Medicare ID - Type Unspecified