Healthcare Provider Details

I. General information

NPI: 1619960846
Provider Name (Legal Business Name): LANCASTER CARE CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2005
Last Update Date: 05/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1350 S MADISON ST
LANCASTER WI
53813-2167
US

IV. Provider business mailing address

1726 N BALLARD RD
APPLETON WI
54911-2444
US

V. Phone/Fax

Practice location:
  • Phone: 608-723-4143
  • Fax: 608-723-7278
Mailing address:
  • Phone: 920-991-9072
  • Fax: 920-749-4021

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number3077
License Number StateWI

VIII. Authorized Official

Name: ROBERT M PARKINS
Title or Position: CFO
Credential:
Phone: 920-364-9754