Marla Vista Manor Assisted Living of Green Bay, LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

Legal business name

MARLA VISTA MANOR ASSISTED LIVING OF GREEN BAY, LLC

Practice address

1006 N Military Ave
Green Bay, WI 54303-4412

Phone

(920) 499-1119

Fax

(920) 499-1191

NPI assigned

Mar 16, 2010

Last updated

Mar 16, 2010By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Katherine R. Tegen

Title

Manager

Phone

(920) 378-5839

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1268697600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1268697600000",
    "number": "1144544354",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "W3124 VAN ROY RD",
            "city": "APPLETON",
            "state": "WI",
            "postal_code": "549153982",
            "telephone_number": "920-574-3833",
            "fax_number": "920-574-3850"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1006 N MILITARY AVE",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543034412",
            "telephone_number": "920-499-1119",
            "fax_number": "920-499-1191"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARLA VISTA MANOR ASSISTED LIVING OF GREEN BAY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-03-16",
        "last_updated": "2010-03-16",
        "status": "A",
        "authorized_official_last_name": "TEGEN",
        "authorized_official_first_name": "KATHERINE",
        "authorized_official_middle_name": "R.",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "920-378-5839"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "WI",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Chester Marcol
• Christina Anne Marien
• Mark Brodhagen DDS SC
• Holli J Marklein, RN
• Victoria Marie Markowski, MS, ATR, LPC-IT
• Myron M Marlett, MD
• Kim Marohl, MA, LPC
• Patti M Marquardt, APNP
• Melissa S Marquart-Carlson, PHD
• Kara S Marquart, PA-C

• Assisted Living Facility in Green Bay, WI
• Providers in Green Bay, WI by specialty
• Assisted Living Facility in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 16, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.