Healthcare Provider Details

I. General information

NPI: 1760333520
Provider Name (Legal Business Name): MENDOTA MANAGEMENT COMPANY, LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2026
Last Update Date: 02/06/2026
Certification Date: 02/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 STRANGEWAY AVE
LODI WI
53555-1307
US

IV. Provider business mailing address

115 STRANGEWAY AVE
LODI WI
53555-1307
US

V. Phone/Fax

Practice location:
  • Phone: 608-219-4080
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number State

VIII. Authorized Official

Name: PETER OUCHAKOF
Title or Position: OWNER
Credential:
Phone: 608-219-4080