Organization
BEAVER DAM AL OPERATIONS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANYA VISTMAN (GC)
(773) 825-3336
Entity
Organization
Contact information
Practice address
104 FAKES CT, BEAVER DAM, WI 53916-2699
(773) 825-3336
Mailing address
8170 MCCORMICK BLVD STE 112, SKOKIE, IL 60076-2914
(763) 439-0320
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
—
—
Other
Enumeration date
12/19/2022
Last updated
12/19/2022
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