Provider Demographics
NPI:1831377258
Name:CARESHARE ASSISTED LIVING, INC.
Entity type:Organization
Organization Name:CARESHARE ASSISTED LIVING, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:ROEGNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:262-644-8035
Mailing Address - Street 1:5726 DEBBIE LN
Mailing Address - Street 2:
Mailing Address - City:WEST BEND
Mailing Address - State:WI
Mailing Address - Zip Code:53095-9134
Mailing Address - Country:US
Mailing Address - Phone:262-644-8035
Mailing Address - Fax:262-644-9604
Practice Address - Street 1:6807 N SANTA MONICA BLVD
Practice Address - Street 2:
Practice Address - City:FOX POINT
Practice Address - State:WI
Practice Address - Zip Code:53217-3941
Practice Address - Country:US
Practice Address - Phone:262-644-8035
Practice Address - Fax:262-644-9604
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-07
Last Update Date:2008-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI0009057310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility