1356435564 NPI number — GOLDEN VIEW, 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 1356435564 NPI number — GOLDEN VIEW, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GOLDEN VIEW, 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:
1356435564
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
700 PILGRIM PKWY STE 200
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ELM GROVE
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53122-2063
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
262-789-9945
Provider Business Mailing Address Fax Number:
262-782-8766

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6526 W BLUEMOUND RD
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:
53213-4064
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
414-453-3606
Provider Business Practice Location Address Fax Number:
414-453-3670
Provider Enumeration Date:
10/03/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
TERESINSKI
Authorized Official First Name:
ADAM
Authorized Official Middle Name:
Authorized Official Title or Position:
MANAGING MEMBER
Authorized Official Telephone Number:
262-470-5388

Provider Taxonomy Codes

  • Taxonomy code: 310400000X , 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)