Provider Demographics
NPI:1023190881
Name:LINDENGROVE COMMUNITIES LLC
Entity Type:Organization
Organization Name:LINDENGROVE COMMUNITIES LLC
Other - Org Name:LINDENGROVE MENOMONEE FALLS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:CHWALA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-206-4983
Mailing Address - Street 1:1045 HILL ST
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:WI
Mailing Address - Zip Code:53098-3015
Mailing Address - Country:US
Mailing Address - Phone:920-261-0400
Mailing Address - Fax:920-261-4840
Practice Address - Street 1:W180N8071 TOWN HALL RD
Practice Address - Street 2:
Practice Address - City:MENOMONEE FALLS
Practice Address - State:WI
Practice Address - Zip Code:53051-3518
Practice Address - Country:US
Practice Address - Phone:262-253-2700
Practice Address - Fax:262-253-2283
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-20
Last Update Date:2023-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2973314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI20164000Medicaid
WI100244145Medicaid