Organization
MARLA VISTA MANOR ASSISTED LIVING OF GREEN BAY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KATHERINE R. TEGEN (MANAGER)
(920) 378-5839
Entity
Organization
Contact information
Practice address
1006 N MILITARY AVE, GREEN BAY, WI 54303-4412
(920) 499-1119
(920) 499-1191
Mailing address
W3124 VAN ROY RD, APPLETON, WI 54915-3982
(920) 574-3833
(920) 574-3850
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
—
WI
Other
Enumeration date
03/16/2010
Last updated
03/16/2010
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