Provider Demographics
NPI:1053426874
Name:ST. CLARE TERRACE
Entity type:Organization
Organization Name:ST. CLARE TERRACE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGEMENT REPRESENTATIVE
Authorized Official - Prefix:
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:
Authorized Official - Last Name:FERGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-546-7330
Mailing Address - Street 1:3553 S 41ST ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53221-1024
Mailing Address - Country:US
Mailing Address - Phone:414-649-0730
Mailing Address - Fax:414-649-0740
Practice Address - Street 1:3553 S 41ST ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53221-1024
Practice Address - Country:US
Practice Address - Phone:414-649-0730
Practice Address - Fax:414-649-0740
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI0010944310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI91121OtherFAMILY CARE