1750736229 NPI number — ASSISTIVE CARE MANAGEMENT, LLC

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 1750736229 NPI number — ASSISTIVE CARE MANAGEMENT, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ASSISTIVE CARE MANAGEMENT, LLC
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:
1750736229
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/03/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1345 W MASON ST
Provider Second Line Business Mailing Address:
SUITE L4
Provider Business Mailing Address City Name:
GREEN BAY
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
54303-2049
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
920-328-3303
Provider Business Mailing Address Fax Number:
888-972-7586

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1345 W MASON ST
Provider Second Line Business Practice Location Address:
SUITE L4
Provider Business Practice Location Address City Name:
GREEN BAY
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54303-2049
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
920-328-3303
Provider Business Practice Location Address Fax Number:
888-972-7586
Provider Enumeration Date:
05/03/2016

Additional Information

Authorized Official

Authorized Official Last Name:
YANG
Authorized Official First Name:
PAYAO
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
920-328-3303

Provider Taxonomy Codes

  • Taxonomy code: 253Z00000X , 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)

  • Identifier: 100039228 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".




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