Provider Demographics
NPI:1144396300
Name:ALEXIAN VILLAGE OF MILWAUKEE, INC.
Entity type:Organization
Organization Name:ALEXIAN VILLAGE OF MILWAUKEE, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:KELLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:GRONEFELD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-729-3500
Mailing Address - Street 1:9301 N 76TH ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53223-1074
Mailing Address - Country:US
Mailing Address - Phone:414-355-9300
Mailing Address - Fax:414-357-5106
Practice Address - Street 1:9255 N 76TH ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53223-1058
Practice Address - Country:US
Practice Address - Phone:414-355-9300
Practice Address - Fax:414-357-5106
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-28
Last Update Date:2024-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI20169500Medicaid
525523Medicare Oscar/Certification