Iconicare Fort Atkinson, LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

Legal business name

ICONICARE FORT ATKINSON, LLC

Practice address

737 Reena Ave
Fort Atkinson, WI 53538-3108

Phone

(920) 542-1521

NPI assigned

Sep 20, 2019

Organization subpart

No

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

Authorized official

Name

Tricia Lies

Title

Director of Financial Services

Phone

(952) 888-2923

Specialties & licenses 1

Addresses

Other names 1

• Reena Senior Living Doing business as

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

{
    "created_epoch": "1568937600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1568937600000",
    "number": "1336790450",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "737 REENA AVE",
            "city": "FORT ATKINSON",
            "state": "WI",
            "postal_code": "535383108"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "737 REENA AVE",
            "city": "FORT ATKINSON",
            "state": "WI",
            "postal_code": "535383108",
            "telephone_number": "920-542-1521"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ICONICARE FORT ATKINSON, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-09-20",
        "last_updated": "2019-09-20",
        "status": "A",
        "authorized_official_last_name": "LIES",
        "authorized_official_first_name": "TRICIA",
        "authorized_official_title_or_position": "DIRECTOR OF FINANCIAL SERVICES",
        "authorized_official_telephone_number": "952-888-2923"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Reena Senior Living",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Assisted Living Facility in Fort Atkinson, WI
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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 20, 2019; 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.