Healthcare Provider Details

I. General information

NPI: 1376077073
Provider Name (Legal Business Name): BRUCE NEENAH SENIOR LIVING, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2017
Last Update Date: 06/11/2025
Certification Date: 06/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2330 BRUCE ST
NEENAH WI
54956-4834
US

IV. Provider business mailing address

2330 BRUCE ST
NEENAH WI
54956-4834
US

V. Phone/Fax

Practice location:
  • Phone: 920-727-1120
  • Fax: 920-727-1585
Mailing address:
  • Phone: 920-727-1120
  • Fax: 920-727-1585

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number StateWI

VIII. Authorized Official

Name: AMBER L TUELLER
Title or Position: SECRETARY
Credential:
Phone: 208-207-2726