Rescare Residentail Services Wisconsin, LLC

Primary specialty

Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityTaxonomy code 320900000X

Legal business name

RESCARE RESIDENTAIL SERVICES WISCONSIN, LLC

Practice address

540 Village Walk LN Ste C
Johnson Creek, WI 53038-9554

Phone

(920) 261-3050

NPI assigned

Aug 21, 2017

Organization subpart

No

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

Authorized official

Name

Angie Mattingly

Title

MGR Provider Enrollment

Phone

(502) 394-2100

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1503273600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1712707200000",
    "number": "1497271449",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "805 N WHITTINGTON PKWY",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402227101",
            "telephone_number": "502-394-2100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "540 VILLAGE WALK LN STE C",
            "city": "JOHNSON CREEK",
            "state": "WI",
            "postal_code": "530389554",
            "telephone_number": "920-261-3050"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RESCARE RESIDENTAIL SERVICES WISCONSIN, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-08-21",
        "last_updated": "2024-04-10",
        "certification_date": "2024-04-10",
        "status": "A",
        "authorized_official_last_name": "MATTINGLY",
        "authorized_official_first_name": "ANGIE",
        "authorized_official_title_or_position": "MGR PROVIDER ENROLLMENT",
        "authorized_official_telephone_number": "502-394-2100"
    },
    "taxonomies": [
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Johnson Creek, WI
• Providers in Johnson Creek, WI by specialty
• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 10, 2024; 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.