Provider Demographics
NPI:1093799272
Name:NEWCASTLE PLACE, INC.
Entity Type:Organization
Organization Name:NEWCASTLE PLACE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR - COO
Authorized Official - Prefix:
Authorized Official - First Name:MARJORIE
Authorized Official - Middle Name:
Authorized Official - Last Name:GOZDOWIAK
Authorized Official - Suffix:
Authorized Official - Credentials:ADMIN, COO
Authorized Official - Phone:262-387-8801
Mailing Address - Street 1:12600 N PORT WASHINGTON RD
Mailing Address - Street 2:#100
Mailing Address - City:MEQUON
Mailing Address - State:WI
Mailing Address - Zip Code:53092-3469
Mailing Address - Country:US
Mailing Address - Phone:262-387-8801
Mailing Address - Fax:262-387-8894
Practice Address - Street 1:12600 N PORT WASHINGTON RD
Practice Address - Street 2:#100
Practice Address - City:MEQUON
Practice Address - State:WI
Practice Address - Zip Code:53092-3469
Practice Address - Country:US
Practice Address - Phone:262-387-8801
Practice Address - Fax:262-387-8894
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1999310400000X
WI235314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Not Answered314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI525668Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER