Lakeshore Manor Memory Care LLC

Primary specialty

Nursing Home AdministratorTaxonomy code 376G00000X

Legal business name

LAKESHORE MANOR MEMORY CARE LLC

Practice address

711 Bay Shore Dr
Oshkosh, WI 54901-5218

Phone

(920) 393-3871

NPI assigned

Mar 14, 2021

Organization subpart

No

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

Authorized official

Name

Anya Vistman

Title

Corp Counsel

Phone

(773) 819-2190

Specialties & licenses 1

Addresses

Electronic endpoints 1

Tax ID family

Lakeshore Manor Memory Care LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

• Lakeshore Manor Memory Care LLC

  • Assisted Living Facility
  • Oshkosh, WI
  • NPI 1417532110
  NPD tax ID

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

{
    "created_epoch": "1615680000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1615680000000",
    "number": "1699350397",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8170 MCCORMICK BLVD STE 112",
            "city": "SKOKIE",
            "state": "IL",
            "postal_code": "600762914",
            "telephone_number": "773-819-2190"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "711 BAY SHORE DR",
            "city": "OSHKOSH",
            "state": "WI",
            "postal_code": "549015218",
            "telephone_number": "920-393-3871"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKESHORE MANOR MEMORY CARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-03-14",
        "last_updated": "2021-03-14",
        "certification_date": "2021-03-14",
        "status": "A",
        "authorized_official_last_name": "VISTMAN",
        "authorized_official_first_name": "ANYA",
        "authorized_official_title_or_position": "CORP COUNSEL",
        "authorized_official_telephone_number": "773-819-2190"
    },
    "taxonomies": [
        {
            "code": "376G00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nursing Home Administrator",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://login.pointclickcare.com/home/userLogin.xhtml",
            "affiliation": "N",
            "address_1": "711 Bay Shore Dr",
            "city": "Oshkosh",
            "state": "WI",
            "country_code": "US",
            "postal_code": "549015218",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Adyson Marie Ladd
• Elizabeth A Lahm, PH.D.
• Lake Pointe Senior Living, Inc.
• Edward Lake, MD
• Lakeshore Manor Memory Care LLC
• Lakeside Neurocare
• Lakeside Neurocare Limited
• Elisa L Lambie, APNP
• Erin M Lamers, PT
• Matthew J Lamers, PT

• Nursing Home Administrator in Oshkosh, WI
• Providers in Oshkosh, WI by specialty
• Nursing Home Administrator in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 14, 2021; 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.