Healthcare Provider Details

I. General information

NPI: 1508790239
Provider Name (Legal Business Name): LILAC SPRINGS ASSISTED LIVINGS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2026
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

403 ONEIL ST
LAKE MILLS WI
53551-1384
US

IV. Provider business mailing address

1848 TIMBERLANDS LN
EAGLE RIVER WI
54521-7503
US

V. Phone/Fax

Practice location:
  • Phone: 920-945-0040
  • Fax: 920-945-2012
Mailing address:
  • Phone: 262-844-3577
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3104A0625X
TaxonomyAssisted Living Facility (Mental Illness)
License Number
License Number State

VIII. Authorized Official

Name: MR. JOHN MORRIS
Title or Position: OWNER
Credential:
Phone: 262-844-3577