1174701502 NPI number — CARESHARE ASSISTED LIVING, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174701502 NPI number — CARESHARE ASSISTED LIVING, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CARESHARE ASSISTED LIVING, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1174701502
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/07/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5726 DEBBIE LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WEST BEND
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53095-9134
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
262-644-8035
Provider Business Mailing Address Fax Number:
262-644-9604

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2780 N MENOMONEE RIVER PKWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MILWAUKEE
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53222-4543
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
262-644-8035
Provider Business Practice Location Address Fax Number:
262-644-9604
Provider Enumeration Date:
02/07/2008

Additional Information

Authorized Official

Authorized Official Last Name:
ROEGNER
Authorized Official First Name:
DEBORAH
Authorized Official Middle Name:
LYNN
Authorized Official Title or Position:
ADMINISTRATIVE SECRETARY
Authorized Official Telephone Number:
262-644-8035

Provider Taxonomy Codes

  • Taxonomy code: 310400000X , with the licence number:  0009058 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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