Basic Information
| Provider Information | |||||||||
| NPI: | 1417058488 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ORION MILWAUKEE LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | HIGHLAND HEIGHTS HEALTHCARE CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1 EASTON OVAL | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432196061 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6144162662 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 3216 W HIGHLAND BLVD | ||||||||
| Address2: | |||||||||
| City: | MILWAUKEE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 532083252 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4143446515 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/25/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | YODER | ||||||||
| AuthorizedOfficialFirstName: | KEITH | ||||||||
| AuthorizedOfficialMiddleName: | JAMES | ||||||||
| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 6144162662 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | 3162 | WI | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
ID Information
| ID | Type | State | Issuer | Description | 20193500 | 05 | WI | MEDICAID |