Healthcare Provider Details

I. General information

NPI: 1942163068
Provider Name (Legal Business Name): VOP 52ND AVE KENOSHA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2025
Last Update Date: 12/05/2025
Certification Date: 12/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4600 52ND AVE
KENOSHA WI
53144-4309
US

IV. Provider business mailing address

4600 52ND AVE
KENOSHA WI
53144-4309
US

V. Phone/Fax

Practice location:
  • Phone: 262-925-0377
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: CHRISTIAN N. CUMMINGS
Title or Position: PRESIDENT
Credential:
Phone: 502-357-9000