Provider Demographics
NPI:1831122431
Name:ASCENSION LIVING - LAKESHORE AT SIENA, INC.
Entity Type:Organization
Organization Name:ASCENSION LIVING - LAKESHORE AT SIENA, INC.
Other - Org Name:LAKESHORE AT SIENA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER -NET REVENUE MGMT & FINANCI
Authorized Official - Prefix:MRS
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:816-596-5608
Mailing Address - Street 1:5643 ERIE ST
Mailing Address - Street 2:
Mailing Address - City:RACINE
Mailing Address - State:WI
Mailing Address - Zip Code:53402-1934
Mailing Address - Country:US
Mailing Address - Phone:262-898-9100
Mailing Address - Fax:262-687-2488
Practice Address - Street 1:5643 ERIE ST
Practice Address - Street 2:
Practice Address - City:RACINE
Practice Address - State:WI
Practice Address - Zip Code:53402-1934
Practice Address - Country:US
Practice Address - Phone:262-898-9100
Practice Address - Fax:262-687-2488
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-08
Last Update Date:2019-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3087314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI20178400Medicaid
WI20178400Medicaid