Basic Information
| Provider Information | |||||||||
| NPI: | 1316580277 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NSH PLYMOUTH-SOUTHERN LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5150 N PORT WASHINGTON RD STE 260 | ||||||||
| Address2: | |||||||||
| City: | MILWAUKEE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 532175470 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4149625250 | ||||||||
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| Practice Location | |||||||||
| Address1: | 930 E CLIFFORD ST | ||||||||
| Address2: | |||||||||
| City: | PLYMOUTH | ||||||||
| State: | WI | ||||||||
| PostalCode: | 530732451 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9208934777 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/23/2019 | ||||||||
| LastUpdateDate: | 10/23/2019 | ||||||||
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| AuthorizedOfficialLastName: | HOEHN | ||||||||
| AuthorizedOfficialFirstName: | JEFFREY | ||||||||
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| AuthorizedOfficialTitleorPosition: | MANAGING MEMBER | ||||||||
| AuthorizedOfficialTelephone: | 4149625250 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 310400000X | Y | Nursing & Custodial Care Facilities | Assisted Living Facility |
No ID Information.