Provider Demographics
NPI:1972732824
Name:DEK CO. INC.
Entity Type:Organization
Organization Name:DEK CO. INC.
Other - Org Name:RAINBOW PARK HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR/OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:E
Authorized Official - Last Name:KENNISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-364-4100
Mailing Address - Street 1:4473 N 105TH ST
Mailing Address - Street 2:
Mailing Address - City:WAUWATOSA
Mailing Address - State:WI
Mailing Address - Zip Code:53225-4509
Mailing Address - Country:US
Mailing Address - Phone:414-438-6620
Mailing Address - Fax:
Practice Address - Street 1:1217 S 118TH ST
Practice Address - Street 2:
Practice Address - City:WEST ALLIS
Practice Address - State:WI
Practice Address - Zip Code:53214-2132
Practice Address - Country:US
Practice Address - Phone:414-257-1208
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-13
Last Update Date:2009-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI310400000X, 3104A0625X, 315P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness
No315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities