Provider Demographics
NPI:1194130732
Name:SENIOR CARE ASSISTED LIVING LLC
Entity type:Organization
Organization Name:SENIOR CARE ASSISTED LIVING LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:
Authorized Official - Last Name:BITTNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-378-1913
Mailing Address - Street 1:3232 N BALLARD RD
Mailing Address - Street 2:SUITE 202 APPLETON
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54911-8804
Mailing Address - Country:US
Mailing Address - Phone:920-574-3833
Mailing Address - Fax:920-574-3850
Practice Address - Street 1:831 E WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:WEST BEND
Practice Address - State:WI
Practice Address - Zip Code:53095-2625
Practice Address - Country:US
Practice Address - Phone:262-335-1992
Practice Address - Fax:262-335-9499
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-23
Last Update Date:2014-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility