Basic Information
| Provider Information | |||||||||
| NPI: | 1326086570 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | COMMUNITY MEMORIAL HOSPITAL OF MENOMONEE FALLS INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | N74 W12501 LEATHERWOOD CT | ||||||||
| Address2: | WOODLAND PRIME 400 STE 103 | ||||||||
| City: | MENOMONEE FALLS | ||||||||
| State: | WI | ||||||||
| PostalCode: | 530514490 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2622573839 | ||||||||
| FaxNumber: | 2622537169 | ||||||||
| Practice Location | |||||||||
| Address1: | W180 N8085 TOWN HALL RD | ||||||||
| Address2: | |||||||||
| City: | MENOMONEE FALLS | ||||||||
| State: | WI | ||||||||
| PostalCode: | 530513518 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2622511000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/02/2006 | ||||||||
| LastUpdateDate: | 10/01/2019 | ||||||||
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| AuthorizedOfficialLastName: | VAN DE KREEKE | ||||||||
| AuthorizedOfficialFirstName: | JEFFREY | ||||||||
| AuthorizedOfficialMiddleName: | R | ||||||||
| AuthorizedOfficialTitleorPosition: | VP FINANCE & TREASURER | ||||||||
| AuthorizedOfficialTelephone: | 4147770968 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | COMMUNITY MEMORIAL HOSPITAL OF MENOMONEE FALLS INC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 273Y00000X | 400800 | WI | Y | Hospital Units | Rehabilitation Unit |
No ID Information.