Organization
LUTHERAN HOMES OF OCONOMOWOC
Active
Other names
Shorehaven Tower Assisted Living
Organization subpart
No
Provider details
NPI number
Authorized official
LORNA GARTZKE (ADMINISTRATOR)
(262) 560-6922
Entity
Organization
Contact information
Practice address
1305 W WISCONSIN AVE, OCONOMOWOC, WI 53066-2646
(262) 567-8341
(262) 567-0273
Mailing address
1305 W WISCONSIN AVE, OCONOMOWOC, WI 53066-2646
(262) 567-8341
(262) 567-0273
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
20152300
—
WI
01
—
52-5560
PTAN
WI
Enumeration date
01/29/2015
Last updated
01/29/2015
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