Healthcare Provider Details

I. General information

NPI: 1184973588
Provider Name (Legal Business Name): NEWCASTLE SENIOR CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2012
Last Update Date: 07/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12600 N PORT WASHINGTON RD
MEQUON WI
53092-3469
US

IV. Provider business mailing address

12600 N PORT WASHINGTON RD
MEQUON WI
53092-3469
US

V. Phone/Fax

Practice location:
  • Phone: 262-387-8800
  • Fax: 262-387-8994
Mailing address:
  • Phone: 262-387-8800
  • Fax: 262-387-8994

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number0016287
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code311500000X
TaxonomyAlzheimer Center (Dementia Center)
License Number0016286
License Number StateWI
# 3
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number235
License Number StateWI

VIII. Authorized Official

Name: ROBERT W. CHAPIN
Title or Position: MANAGER OF MANAGING MEMBER
Credential:
Phone: 407-999-2400