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General NPI Number Information
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NPI Number | 1043462021
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Entity Type | Organization
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Legal Business Name | CROWN POINT VILLAGE, LLC
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Dates
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Enumeration Date | 10/21/2008
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Last Update Date | 10/21/2008
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Provider Practice Location Address
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Address Line | 881 LIBERTY BOULEVARD
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City | SUN PRAIRIE
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State | WI
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Zip | 53590
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Country | US
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Telephone | 608-834-2073
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Fax | 608-834-2089
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Provider Business Mailing Address
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Address Line | PO BOX 1255
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City | SUN PRAIRIE
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State | WI
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Zip | 53590-6255
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Country | US
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Telephone | 608-318-1180
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Fax | 608-318-0878
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Authorized Official
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Title or Position | EXECUTIVE MANAGER
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Name | ROBERT DONALD SIMONSON
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Credential |
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Telephone | 608-318-1180
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | 12519
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License Number State | WI
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