Healthcare Provider Details

I. General information

NPI: 1417661703
Provider Name (Legal Business Name): AGRACE ADULT DAY CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2023
Last Update Date: 01/11/2023
Certification Date: 01/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1702 W BELTLINE HWY
MADISON WI
53713-2332
US

IV. Provider business mailing address

5395 E CHERYL PKWY
FITCHBURG WI
53711-5395
US

V. Phone/Fax

Practice location:
  • Phone: 608-327-7303
  • Fax:
Mailing address:
  • Phone: 608-276-4660
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LYNNE SEXTEN
Title or Position: CEO PRESIDENT
Credential:
Phone: 608-276-4660