Provider Demographics
NPI:1578754511
Name:KENNETH J & MARILYN M SECOR
Entity Type:Organization
Organization Name:KENNETH J & MARILYN M SECOR
Other - Org Name:LINDEN MANOR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:J
Authorized Official - Last Name:SECOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-388-0110
Mailing Address - Street 1:1204 FOURTH ST
Mailing Address - Street 2:
Mailing Address - City:KEWAUNEE
Mailing Address - State:WI
Mailing Address - Zip Code:54216
Mailing Address - Country:US
Mailing Address - Phone:920-388-0110
Mailing Address - Fax:920-388-2202
Practice Address - Street 1:1204 FOURTH ST
Practice Address - Street 2:
Practice Address - City:KEWAUNEE
Practice Address - State:WI
Practice Address - Zip Code:54216
Practice Address - Country:US
Practice Address - Phone:920-388-0110
Practice Address - Fax:920-388-2202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-06
Last Update Date:2007-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI410404310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility