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General NPI Number Information
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NPI Number | 1053291476
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Entity Type | Organization
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Legal Business Name | LAKE MILLS AL, LLC
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Dates
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Enumeration Date | 09/05/2025
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Last Update Date | 09/05/2025
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Provider Practice Location Address
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Address Line | 300 ONEIL ST
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City | LAKE MILLS
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State | WI
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Zip | 53551-1365
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Country | US
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Telephone | 877-295-3747
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Fax |
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Provider Business Mailing Address
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Address Line | 600 3RD AVE FL 21
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City | NEW YORK
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State | NY
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Zip | 10016-1916
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Country | US
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Telephone | 646-314-4327
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Fax |
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Authorized Official
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Title or Position | LICENSING PROJECT COORDINATOR
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Name | DIANE GABRIELE LIMBURG
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Credential |
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Telephone | 951-552-0109
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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 |
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License Number State |
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