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General NPI Number Information
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NPI Number | 1962102632
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Entity Type | Organization
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Legal Business Name | INSPIRED SENIOR LIVING OF MEQUON MT, LLC
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Dates
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Enumeration Date | 03/09/2023
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Last Update Date | 03/09/2023
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Provider Practice Location Address
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Address Line | 10995 N MARKET ST
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City | MEQUON
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State | WI
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Zip | 53092-4952
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Country | US
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Telephone | 262-478-1500
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Fax |
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Provider Business Mailing Address
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Address Line | 7047 E GREENWAY PKWY STE 300
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City | SCOTTSDALE
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State | AZ
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Zip | 85254-8116
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | LUKE LEE
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Credential |
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Telephone | 480-748-4339
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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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