Active NPI
Larrita S Jones
- Assisted Living Facility
- West Bend, WI
National Provider Identifier
1558060814
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Assisted Living Facility
- License
- 0019012
- Practice address
- 617 James CT
West Bend, WI 53095-4211 - Phone
- (414) 517-9011
- NPI assigned
- Feb 27, 2023
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Assisted Living Facility | 310400000X | 0019012 | WI | Primary |
Addresses
Primary practice location
617 James CT
West Bend, WI 53095-4211
Mailing address
617 James CT
West Bend, WI 53095-4211
Phone (414) 517-9011
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 87-4334851 | Other | WI | IRS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0019012 | WI | MD | Assisted Living Facility |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1677456000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1677456000000",
"number": "1558060814",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "617 JAMES CT",
"city": "WEST BEND",
"state": "WI",
"postal_code": "530954211",
"telephone_number": "414-517-9011"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "617 JAMES CT",
"city": "WEST BEND",
"state": "WI",
"postal_code": "530954211",
"telephone_number": "414-517-9011"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JONES",
"first_name": "LARRITA",
"middle_name": "S",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2023-02-27",
"last_updated": "2023-02-27",
"certification_date": "2023-02-25",
"status": "A"
},
"taxonomies": [
{
"code": "310400000X",
"taxonomy_group": "",
"desc": "Assisted Living Facility",
"state": "WI",
"license": "0019012",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "IRS",
"identifier": "87-4334851",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Other providers in West Bend, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 27, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.