Beaver Dam Assisted Living, LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

Legal business name

BEAVER DAM ASSISTED LIVING, LLC

Doing business as

Beaver Dam Assisted Living and Memory Care

Practice address

104 Fakes CT
Beaver Dam, WI 53916-2699

Phone

(920) 356-9818

NPI assigned

May 31, 2019

Last updated

Jul 3, 2020By 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

Miss Barbara Ann Bittner

Title

Coo

Phone

(920) 378-1913

Specialties & licenses 2

Addresses

Other names 1

• Beaver Dam Assisted Living and Memory Care Doing business as

Locations

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

{
    "created_epoch": "1559260800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1593734400000",
    "number": "1265090559",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5555 W GRANDE MARKET DR STE A",
            "city": "APPLETON",
            "state": "WI",
            "postal_code": "549138170",
            "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": "104 FAKES CT",
            "city": "BEAVER DAM",
            "state": "WI",
            "postal_code": "539162699",
            "telephone_number": "920-356-9818"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "129 Evergreen Cir",
            "address_purpose": "LOCATION",
            "city": "Beaver Dam",
            "state": "WI",
            "postal_code": "539163512",
            "country_code": "US",
            "telephone_number": "920-356-9818",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "BEAVER DAM ASSISTED LIVING, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-05-31",
        "last_updated": "2020-07-03",
        "certification_date": "2020-07-03",
        "status": "A",
        "authorized_official_last_name": "BITTNER",
        "authorized_official_first_name": "BARBARA",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "920-378-1913",
        "authorized_official_name_prefix": "Miss"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "311500000X",
            "taxonomy_group": "",
            "desc": "Alzheimer Center (Dementia Center)",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Beaver Dam Assisted Living and Memory Care",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Beaver Dam Assisted Living and Memory Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Seth Mathew Barudin, MD
• Susan Marie Baumann, OTR
• Timothy J Baumann, OTA
• Devyn Beaugh, PHARM.D.
• Beaver Dam Al Operations LLC
• Beaver Dam Community Hospitals Inc (Marshfield Medical Center - Beaver Dam)
• Beaver Dam Community Hospitals Inc ((inactive) Marshfield Medical Center - Beaver Dam Hospitalist Group)
• Beaver Dam Community Hospitals Inc (Marshfield Medical Center - Beaver Dam Pharmacy (Part B Immunization))
• Beaver Dam Community Hospitals Inc ((Inactive) Marshfield Medical Center - Beaver Dam Sleep Center)
• Beaver Dam Community Hospitals Inc (Hillside Unit Pharmacy (DME))

• Assisted Living Facility in Beaver Dam, WI
• Providers in Beaver Dam, 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 Jul 3, 2020; 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.