PH Kenosha LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

Legal business name

PH KENOSHA LLC

Doing business as

Kenosha Estates Living and Care Center

Practice address

1703 60TH St
Kenosha, WI 53140-3986

Phone

(262) 658-4125

NPI assigned

Feb 11, 2011

Last updated

Feb 11, 2011By 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

Benjamin Klein

Title

Member

Phone

(847) 329-4100

Specialties & licenses 1

Addresses

Other names 1

• Kenosha Estates Living and Care Center Doing business as

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

{
    "created_epoch": "1297382400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1297382400000",
    "number": "1609173590",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7444 LONG AVE",
            "city": "SKOKIE",
            "state": "IL",
            "postal_code": "600773214",
            "telephone_number": "847-329-4100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1703 60TH ST",
            "city": "KENOSHA",
            "state": "WI",
            "postal_code": "531403986",
            "telephone_number": "262-658-4125"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PH KENOSHA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-02-11",
        "last_updated": "2011-02-11",
        "status": "A",
        "authorized_official_last_name": "KLEIN",
        "authorized_official_first_name": "BENJAMIN",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "847-329-4100"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Kenosha Estates Living and Care Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Tina Anne-Marie Peterson, D.C.
• John D Pettinger, M.D.
• Mary Pettit, RN
• Bethany Pfeiffer
• Elizabeth Pflug-Froh, PT
• Huong Pham, OTR
• Sarah Phelps-Digman, MSW INTERN
• Rita Diana Philip, DDS
• Madeleine Germaine Philipp, PT, DPT
• Phoenixc Healthcare, SC

• Skilled Nursing Facility in Kenosha, WI
• Providers in Kenosha, WI by specialty
• Skilled Nursing Facility in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 11, 2011; 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.