Mary Jude Health Care, Inc.

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

2962 Issued in WI

Legal business name

MARY JUDE HEALTH CARE, INC.

Practice address

9806 W Lincoln Ave
West Allis, WI 53227-2234

Phone

(414) 543-5330

NPI assigned

May 23, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Michael Frisby

Title

Administrator

Phone

(414) 543-5330

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Mary Jude Nursing Home Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1179878400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1902016090",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9806 W LINCOLN AVE",
            "city": "WEST ALLIS",
            "state": "WI",
            "postal_code": "532272234",
            "telephone_number": "414-543-5330"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9806 W LINCOLN AVE",
            "city": "WEST ALLIS",
            "state": "WI",
            "postal_code": "532272234",
            "telephone_number": "414-543-5330"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARY JUDE HEALTH CARE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-23",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "FRISBY",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "414-543-5330"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "WI",
            "license": "2962",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "20163400",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mary Jude Nursing Home",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Hailey Martin, DPT
• Luverda C Martin, CNM
• Aldo Martinez Vaca, M.D.
• Holly Martinez
• Matthew Francisco Martinez
• Julie Ann Marzluf, MS CCC-SLP
• Cynthia Lynn Mason, M.D.
• Sunya Masood, OD
• Masroor Munim MD
• Robin Lynn Mastera

• Skilled Nursing Facility in West Allis, WI
• Providers in West Allis, WI by specialty
• Skilled Nursing Facility in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.