Healthcare Provider Details

I. General information

NPI: 1902576374
Provider Name (Legal Business Name): HIGH POINT ASSISTED LIVING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2021
Last Update Date: 09/20/2021
Certification Date: 09/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 BETH CT
BURLINGTON WI
53105-1716
US

IV. Provider business mailing address

155 BETH CT
BURLINGTON WI
53105-1716
US

V. Phone/Fax

Practice location:
  • Phone: 262-492-3511
  • Fax: 262-767-1233
Mailing address:
  • Phone: 262-492-3511
  • Fax: 262-767-1233

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State

VIII. Authorized Official

Name: RICK WASMUND
Title or Position: OWNER/ADMINISTRATOR
Credential:
Phone: 262-492-3511