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General NPI Number Information
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NPI Number | 1760127237
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Entity Type | Organization
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Legal Business Name | RIPON COPPERLEAF AL OPERATIONS LLC
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Dates
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Enumeration Date | 04/29/2022
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Last Update Date | 04/29/2022
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Provider Practice Location Address
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Address Line | 1002 EUREKA ST
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City | RIPON
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State | WI
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Zip | 54971-1141
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Country | US
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Telephone | 920-896-0440
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Fax |
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Provider Business Mailing Address
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Address Line | 8170 MCCORMICK BLVD STE 112
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City | SKOKIE
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State | IL
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Zip | 60076-2914
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Country | US
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Telephone | 773-825-3336
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | MAXIM STESEL
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Credential |
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Telephone | 773-825-3336
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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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