NPIMap

Organization Active NPI

CCRC Opco - Freedom Square, LLC

  • Assisted Living Facility
  • Milwaukee, WI
National Provider Identifier
1609260371
Registry record updated Mar 20, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Assisted Living FacilityTaxonomy code 310400000X
License
AL4759 Issued in FL
Legal business name
CCRC OPCO - FREEDOM SQUARE, LLC
Practice address
6737 W Washington St
Suite 2300
Milwaukee, WI 53214-5647
Phone
(414) 918-5000
NPI assigned
Mar 20, 2015
Organization subpart
Yes
Parent organization
BROOKDALE SENIOR LIVING, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 20, 2015

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

Authorized official

Name
Mr. Mark W Ohlendorf
Title
President
Phone
(414) 918-5000

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Assisted Living Facility 310400000X AL4759 FL Primary

Addresses

Primary practice location

6737 W Washington St
Suite 2300
Milwaukee, WI 53214-5647

Mailing address

10801 Johnson Blvd
Seminole, FL 33772-4746
Phone (727) 398-0379

Other names 1

  • The Inn at Freedom Square Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Arc Freedom Square LLC4 organizations share this tax ID, including this one
Part of
Brookdale Senior Living Inc

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

Locations

10801 Johnson Blvd
Seminole, FL 33772
Phone (727) 398-0166

NPI Registry JSON

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

{
    "created_epoch": "1426809600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1426809600000",
    "number": "1609260371",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10801 JOHNSON BLVD",
            "city": "SEMINOLE",
            "state": "FL",
            "postal_code": "337724746",
            "telephone_number": "727-398-0379",
            "fax_number": "727-398-0461"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6737 W WASHINGTON ST",
            "address_2": "SUITE 2300",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532145647",
            "telephone_number": "414-918-5000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CCRC OPCO - FREEDOM SQUARE, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "BROOKDALE SENIOR LIVING, INC.",
        "enumeration_date": "2015-03-20",
        "last_updated": "2015-03-20",
        "status": "A",
        "authorized_official_last_name": "OHLENDORF",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "414-918-5000",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "FL",
            "license": "AL4759",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The Inn at Freedom Square",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Milwaukee, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 20, 2015; 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.