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Organization

LINCOLN LUTHERAN COMMUNITY CARE CORPORATION

Active
Parent organization
LINCOLN LUTHERAN HOME OF RACINE INC.
Other names
Becker Shoop Center
Organization subpart
Yes

Provider details

NPI number
Legal business name
LINCOLN LUTHERAN HOME OF RACINE INC.
Authorized official
FRED RICHARD BOVA JR. CPA (CHIEF FINANCIAL OFFICER)
(262) 898-2701
Entity
Organization

Contact information

Practice address
6101 16TH STREET, RACINE, WI 53406
(262) 637-7486
(262) 633-3045
Mailing address
2000 DOMANIK DRIVE, RACINE, WI 53404
(262) 633-0500
(262) 633-3045

Taxonomy

Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
3179
WI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
20177300
WI
Enumeration date
10/25/2006
Last updated
02/16/2012
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