Provider Demographics
NPI:1417661703
Name:AGRACE ADULT DAY CENTER LLC
Entity Type:Organization
Organization Name:AGRACE ADULT DAY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LYNNE
Authorized Official - Middle Name:
Authorized Official - Last Name:SEXTEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-276-4660
Mailing Address - Street 1:5395 E CHERYL PKWY
Mailing Address - Street 2:
Mailing Address - City:FITCHBURG
Mailing Address - State:WI
Mailing Address - Zip Code:53711-5395
Mailing Address - Country:US
Mailing Address - Phone:608-276-4660
Mailing Address - Fax:
Practice Address - Street 1:1702 W BELTLINE HWY
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53713-2332
Practice Address - Country:US
Practice Address - Phone:608-327-7303
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AGRACE HOSPICECARE, INCORPORATED
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-01-11
Last Update Date:2023-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI0019098OtherSTATE OF WISCONSIN DEPT OF HEALTH SERVICES ADULT DAY CARE CERTIFICATE