MEDICARE: NEWCASTLE SENIOR CARE, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	311500000X	Alzheimer Center (Dementia Center)	0016286	WI
2	310400000X	Assisted Living Facility	0016287	WI
3	314000000X	Skilled Nursing Facility	235	WI

General Provider Information

NPI Number	:	1184973588
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEWCASTLE SENIOR CARE, LLC

Provider Business Mailing Address
First Line	:	12600 N PORT WASHINGTON RD
Second Line	:
City	:	MEQUON
State	:	WI
Zip	:	53092-3469
Country	:	US
Telephone Number	:	262-387-8800
Fax Number	:	262-387-8994

Provider Business Practice Location Address
First Line	:	12600 N PORT WASHINGTON RD
Second Line	:
City	:	MEQUON
State	:	WI
Zip	:	53092-3469
Country	:	US
Telephone Number	:	262-387-8800
Fax Number	:	262-387-8994

Authorized Official
Title or Position	:	MANAGER OF MANAGING MEMBER
Name	:	ROBERT W. CHAPIN
Credential	:
Telephone Number	:	407-999-2400

Provider Enumeration Date	:	08/31/2012
Last Update Date	:	07/12/2019

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