Healthcare Provider Details

I. General information

NPI: 1538023155
Provider Name (Legal Business Name): FORT ATKINSON WI OPCO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/10/2025
Last Update Date: 12/10/2025
Certification Date: 12/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

430 WILCOX ST
FORT ATKINSON WI
53538-1968
US

IV. Provider business mailing address

300 BOULEVARD OF THE AMERICAS STE 101
LAKEWOOD NJ
08701
US

V. Phone/Fax

Practice location:
  • Phone: 920-563-5533
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: AHARON FRANCO
Title or Position: AUTHORIZED REPRESENTATIVE
Credential:
Phone: 646-823-6464