Provider Demographics
NPI:1487654935
Name:BENEVOLENT CORPORATION CEDAR COMMUNITY
Entity Type:Organization
Organization Name:BENEVOLENT CORPORATION CEDAR COMMUNITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT OF FINANCE
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:T
Authorized Official - Last Name:PICHLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:262-306-4212
Mailing Address - Street 1:5555 CEDAR BAY
Mailing Address - Street 2:
Mailing Address - City:WEST BEND
Mailing Address - State:WI
Mailing Address - Zip Code:53095-7602
Mailing Address - Country:US
Mailing Address - Phone:262-306-2130
Mailing Address - Fax:262-306-2131
Practice Address - Street 1:5555 CEDAR BAY
Practice Address - Street 2:
Practice Address - City:WEST BEND
Practice Address - State:WI
Practice Address - Zip Code:53095-7602
Practice Address - Country:US
Practice Address - Phone:262-306-2130
Practice Address - Fax:262-306-2131
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BENEVOLENT CORPORATION CEDAR COMMUNITY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-07-27
Last Update Date:2019-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WICERTIFICATION# 022310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility