Provider Demographics
NPI:1568810422
Name:SCAL OF HOBART, LLC
Entity Type:Organization
Organization Name:SCAL OF HOBART, LLC
Other - Org Name:EMERALD RIDGE ASSISTED LIVING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:R
Authorized Official - Last Name:TEGEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-378-1913
Mailing Address - Street 1:3232 N BALLARD RD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54911-8804
Mailing Address - Country:US
Mailing Address - Phone:920-574-3833
Mailing Address - Fax:920-574-3850
Practice Address - Street 1:650 CENTENNIAL CENTRE BLVD
Practice Address - Street 2:
Practice Address - City:HOBART
Practice Address - State:WI
Practice Address - Zip Code:54155-8989
Practice Address - Country:US
Practice Address - Phone:920-544-5041
Practice Address - Fax:920-544-0857
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-01
Last Update Date:2016-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility