Kettle Park Senior Living Inc

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

Legal business name

KETTLE PARK SENIOR LIVING INC

Doing business as

Kettle Park Senior Living

Practice address

2600 Jackson St
Stoughton, WI 53589-9142

Phone

(608) 579-5601

NPI assigned

Sep 20, 2019

Last updated

Sep 20, 2019By 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

Tricia Lies

Title

Director of Financial Services

Phone

(952) 888-2923

Specialties & licenses 1

Addresses

Other names 1

• Kettle Park Senior Living Doing business as

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

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": "1649821661",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2600 JACKSON ST",
            "city": "STOUGHTON",
            "state": "WI",
            "postal_code": "535899142",
            "telephone_number": "608-579-5601"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2600 JACKSON ST",
            "city": "STOUGHTON",
            "state": "WI",
            "postal_code": "535899142",
            "telephone_number": "608-579-5601"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KETTLE PARK SENIOR LIVING INC",
        "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": "Kettle Park Senior Living",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Terry David Johnson, R.PH.
• Lori Julson, CPHT
• K.O. Bodyworks
• Jessica Kaltenberg
• Kelsy J Kerrigan
• Jennifer Keupper Oneil
• Nancy Keys, R.N.
• Ahsan Khalid, MD
• Angela Michele Kiesling, COTA
• Stephanie Marie Kind

• Assisted Living Facility in Stoughton, WI
• Providers in Stoughton, WI by specialty
• Assisted Living Facility in Wisconsin

• 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.