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Organization

HEATHERLYN ASSISTED LIVING LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
JHIENELLE TALETHIA KISTLE (EXECUTIVE DIRECTOR)
(920) 397-1610
Entity
Organization

Contact information

Practice address
811 ROBERT ST, FORT ATKINSON, WI 53538-1140
(920) 397-1610
Mailing address
327 E CLAY ST UNIT 19, WHITEWATER, WI 53190-2077
(920) 397-1610

Taxonomy

Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary

Other

Enumeration date
02/09/2020
Last updated
02/09/2020
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