Provider Demographics
NPI:1689890204
Name:HOPLITE, INC.
Entity Type:Organization
Organization Name:HOPLITE, INC.
Other - Org Name:RACINE RESIDENTIAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:NORMAN
Authorized Official - Middle Name:L
Authorized Official - Last Name:STEFFEN
Authorized Official - Suffix:
Authorized Official - Credentials:NHA
Authorized Official - Phone:262-633-6348
Mailing Address - Street 1:1719 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:RACINE
Mailing Address - State:WI
Mailing Address - Zip Code:53403-2019
Mailing Address - Country:US
Mailing Address - Phone:262-633-6348
Mailing Address - Fax:262-633-4282
Practice Address - Street 1:1719 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:RACINE
Practice Address - State:WI
Practice Address - Zip Code:53403-2019
Practice Address - Country:US
Practice Address - Phone:262-633-6348
Practice Address - Fax:262-633-4282
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI20001500Medicaid