Provider Demographics
NPI:1922327634
Name:AMERICANWAY OF MADISON LLC
Entity Type:Organization
Organization Name:AMERICANWAY OF MADISON LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:JANIS
Authorized Official - Middle Name:DEETS
Authorized Official - Last Name:NOWAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-566-1500
Mailing Address - Street 1:602 E ALBERT ST
Mailing Address - Street 2:SUITE 3
Mailing Address - City:PORTAGE
Mailing Address - State:WI
Mailing Address - Zip Code:53901-1463
Mailing Address - Country:US
Mailing Address - Phone:608-566-1500
Mailing Address - Fax:608-566-1501
Practice Address - Street 1:734 MESTA LN
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53704-7843
Practice Address - Country:US
Practice Address - Phone:608-246-0409
Practice Address - Fax:608-246-9020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-19
Last Update Date:2010-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI00127913104A0625X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness