Provider Demographics
NPI:1093442980
Name:MS-AC KAUKAUNA SENIOR LIVING, LLC
Entity Type:Organization
Organization Name:MS-AC KAUKAUNA SENIOR LIVING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CATIE
Authorized Official - Middle Name:
Authorized Official - Last Name:RIEBE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-462-4018
Mailing Address - Street 1:793 TARRAGON DR
Mailing Address - Street 2:
Mailing Address - City:KAUKAUNA
Mailing Address - State:WI
Mailing Address - Zip Code:54130-3075
Mailing Address - Country:US
Mailing Address - Phone:920-462-4018
Mailing Address - Fax:920-758-0820
Practice Address - Street 1:793 TARRAGON DR
Practice Address - Street 2:
Practice Address - City:KAUKAUNA
Practice Address - State:WI
Practice Address - Zip Code:54130-3075
Practice Address - Country:US
Practice Address - Phone:920-462-4018
Practice Address - Fax:920-758-0820
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-02
Last Update Date:2022-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No311500000XNursing & Custodial Care FacilitiesAlzheimer Center (Dementia Center)