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General NPI Number Information
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NPI Number | 1205011806
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Entity Type | Organization
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Legal Business Name | MEADOWMERE OAK CREEK MANAGEMENT, LLC
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Dates
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Enumeration Date | 01/02/2008
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Last Update Date | 01/02/2008
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Provider Practice Location Address
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Address Line | 701 E PUETZ RD
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City | OAK CREEK
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State | WI
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Zip | 53154-3257
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Country | US
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Telephone | 414-766-2100
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Fax |
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Provider Business Mailing Address
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Address Line | 701 E PUETZ RD
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City | OAK CREEK
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State | WI
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Zip | 53154-3257
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Country | US
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Telephone | 414-766-2100
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Fax |
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Authorized Official
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Title or Position | CHIEF FINANCIAL OFFICER
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Name | MR. JOHN CARL ROGGE
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Credential |
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Telephone | 414-615-7144
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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 | 10340
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License Number State | WI
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