Provider Demographics
NPI:1205011806
Name:MEADOWMERE OAK CREEK MANAGEMENT, LLC
Entity Type:Organization
Organization Name:MEADOWMERE OAK CREEK MANAGEMENT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:CARL
Authorized Official - Last Name:ROGGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-615-7144
Mailing Address - Street 1:701 E PUETZ RD
Mailing Address - Street 2:
Mailing Address - City:OAK CREEK
Mailing Address - State:WI
Mailing Address - Zip Code:53154-3257
Mailing Address - Country:US
Mailing Address - Phone:414-766-2100
Mailing Address - Fax:
Practice Address - Street 1:701 E PUETZ RD
Practice Address - Street 2:
Practice Address - City:OAK CREEK
Practice Address - State:WI
Practice Address - Zip Code:53154-3257
Practice Address - Country:US
Practice Address - Phone:414-766-2100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-02
Last Update Date:2008-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI10340310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility