Organization Name: | KENNETH J & MARILYN M SECOR |
NPI Number: | 1578754511 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | KENNETH J SECOR (OWNER) |
Mailing Address: | 1204 Fourth St Kewaunee |
State: | WI US |
Postal Code: | 54216 |
Phone Number: | 9203880110 |
Fax Number: | 9203882202 |
NPI Enumeration Date: | 08/06/2007 |
NPI Last Update Date: | 08/06/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 310400000X |
License Number: | 410404 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | WI |
Taxonomy Type: | Nursing & Custodial Care Facilities |
Taxonomy Classification: | Assisted Living Facility |
Taxonomy Specialization: | |
Taxonomy Definition: | A facility providing supportive services to individuals who can function independently in most areas of activity, but need assistance and/or monitoring to assure safety and well being. |