KENOSHA SENIOR LIVING, INC. (NPI# 1790169944) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1790169944 |
| Entity Type | Organization |
| Organization Name | KENOSHA SENIOR LIVING, INC. |
| Other Organization Name | KENOSHA SENIOR LIVING |
| Practice Address |
3109 30th Ave Kenosha WI 53144-1673 |
| Practice Telephone | 2626561795 |
| Practice Fax Number | 2626561875 |
| Mailing Telephone | 2626561795 |
| Mailing Fax Number | 2626561875 |
| Enumeration Date | 2015-07-17 |
| Last Update Date | 2020-01-22 |
| Authorized Official Name | LEE JOHNSON (TREASURER) |
| Authorized Official Telephone | 2084011369 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 310400000X | Assisted Living Facility | Nursing & Custodial Care Facilities |
| Other Name | Type Code |
|---|---|
| Kenosha Senior Living | Doing Business As Name - Organization |
| Street Address |
3109 30TH AVE |
| City | KENOSHA |
| State | WI |
| Zip Code | 53144-1673 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1750704656 | Amanda Kay Kreuzer | Occupational Therapy Assistant | 3109 30th Ave, Kenosha, WI 53144 | 2014-01-28 |
| 1598165631 | Hannah David | Speech-Language Pathologist | 3109 30th Ave, Kenosha, WI 53144-1673 | 2014-08-26 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1902410202 | Dpt Holdings LLC | Occupational Therapist | 3825 39th Ave #110, Kenosha, WI 53144 | 2020-09-03 |
| 1225641392 | Eunice Boatin | Social Worker | Kenosha Human Development Services, 3536 52nd Street, Kenosha, WI 53144 | 2020-08-28 |
| 1881250256 | Shoptikal LLC | Eyewear Supplier (Equipment, not the service) | 3621 Market Lane, Kenosha, WI 53144 | 2019-05-11 |
| 1124540067 | Kaitlyn King | Speech-Language Pathologist | 5219 88th Ave., Kenosha, WI 53144 | 2017-07-12 |
| 1174992721 | Claire Ann Adams | Acupuncturist | 5416 52nd Street, Kenosha, WI 53144 | 2015-09-24 |
| 1285017087 | Jessica Lynn Gillengerten | Acupuncturist | 4235 Green Bay Rd., Suite #10, Kenosha, WI 53144 | 2015-06-30 |
| 1841626785 | B7 Pharmacy Inc | Pharmacy | 3825 39th Ave Ste 100, Kenosha, WI 53144 | 2013-09-24 |
| 1124326764 | Wisconsin Cvs Pharmacy LLC | Durable Medical Equipment & Medical Supplies | 3710 57th Ave, Kenosha, WI 53144 | 2011-03-07 |
| 1982931291 | Roman Bilak | General Practice | 4126 - 7th Street, Kemosha, WI 53144 | 2009-11-06 |
| 1306081658 | Doni Beth Davis | Chiropractor | 3720 - 72nd Avenue, Kenosha, WI 53144 | 2008-12-15 |
| Find all providers in zip 53144 | ||||
| Taxonomy Code | 310400000X |
| Grouping | Nursing & Custodial Care Facilities |
| Classification | Assisted Living Facility |
| A facility providing supportive services to individuals who can function independently in most areas of activity, but need assistance and/or monitoring to assure safety and well being. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1669874848 | Brookdale Senior Living Communities, Inc. | Assisted Living Facility | 7377 88th Ave, Kenosha, WI 53142-8206 | 2014-09-19 |
| 1992107387 | Brookdale Senior Living Communities, Inc. | Assisted Living Facility | 10108 74th St, Kenosha, WI 53142-7514 | 2014-09-17 |
| 1215246848 | Five Star Quality Care-wi, LLC | Assisted Living Facility | 8351 Sheridan Rd, Kenosha, WI 53143-6339 | 2010-09-30 |
| 1376608083 | Eye Care 4 U, S.c. | Assisted Living Facility | 5455 Sheridan Rd, Ll20, Kenosha, WI 53140-3734 | 2006-12-22 |
| 1487202123 | Snh Wis Tenant LLC | Assisted Living Facility | 8351 Sheridan Rd, Kenosha, WI 53143-6339 | 2019-08-27 |
| 1093273427 | American Eagle Pleasant Prairie LLC | Assisted Living Facility | 7377 88th Ave, Kenosha, WI 53142-8206 | 2019-03-05 |
| 1134653843 | Somers Kenosha Senior Living, Inc. | Assisted Living Facility | 3109 12th St, Kenosha, WI 53144-2915 | 2017-04-19 |
| 1982006383 | Brookdale Senior Living Communities, Inc. | Assisted Living Facility | 3109 12th St, Kenosha, WI 53144-2915 | 2014-09-17 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1326654534 | Praitie Assisted Living Inc. | Assisted Living Facility | 749 E Oshkosh St, Ripon, WI 54971-1258 | 2020-09-22 |
| 1295340016 | St. Elizabeth Manor, Inc. | Assisted Living Facility | 111 Commercial Dr, Footville, WI 53537 | 2020-09-09 |
| 1730793001 | Zinzendorf Hall, Inc. | Assisted Living Facility | 1047 Hill St, Watertown, WI 53098-3015 | 2020-09-03 |
| 1184236044 | Francine Carter | Assisted Living Facility | 4341 N 19th St, Milwaukee, WI 53209-6831 | 2020-08-20 |
| 1598377905 | Nohc Jackson Senior Living LLC | Assisted Living Facility | N16744 Eagle Drive, Jackson, WI 53037 | 2020-08-18 |
| 1003427766 | Nohc Magnolia Meadows LLC | Assisted Living Facility | 1480 N 7th St, Manitowoc, WI 54220-2012 | 2020-08-14 |
| 1922616580 | Rheuvonia Reed | Assisted Living Facility | 543 E Arbor Cir, Oak Creek, WI 53154-8528 | 2020-07-20 |
| 1912515073 | Baldwin Coh, LLC | Assisted Living Facility | 1880 4th Ave, Baldwin, WI 54002-5134 | 2020-07-15 |
| 1427666593 | Hudson Coh II, LLC | Assisted Living Facility | 805 Heggen St, Hudson, WI 54016-5005 | 2020-07-15 |
| 1366050429 | Hudson Coh, LLC | Assisted Living Facility | 1111 Heggen St, Hudson, WI 54016-9222 | 2020-07-15 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.