=====================================================
General NPI Number Information
=====================================================
NPI Number | 1194930743
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HOPE SENIOR LIVING, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/14/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 475 GROVE ST
-----------------------------------------------------
City | LOMIRA
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53048-9355
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 920-269-4386
-----------------------------------------------------
Fax | 920-269-4978
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 13691
-----------------------------------------------------
City | WAUWATOSA
-----------------------------------------------------
State | WI
-----------------------------------------------------
Zip | 53213-0691
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 920-269-4386
-----------------------------------------------------
Fax | 920-269-4978
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EXECUTIVE DIRECTOR
-----------------------------------------------------
Name | STEVEN KURANZ
-----------------------------------------------------
Credential | NHA
-----------------------------------------------------
Telephone | 920-269-4386
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 310400000X
-----------------------------------------------------
Taxonomy Name | Assisted Living Facility
-----------------------------------------------------
License Number | 0011836
-----------------------------------------------------
License Number State | WI
-----------------------------------------------------