Fred & Mamie's Home, Inc

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

Legal business name

FRED & MAMIE'S HOME, INC

Practice address

143 School Creek TRL
Luxemburg, WI 54217-1095

Phone

(920) 845-5950

NPI assigned

Jul 12, 2007

Organization subpart

No

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

Authorized official

Name

Sharon Ann Depeau

Title

President/Owner

Phone

(920) 845-5950

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1184198400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1184198400000",
    "number": "1740489558",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "143 SCHOOL CREEK TRL",
            "city": "LUXEMBURG",
            "state": "WI",
            "postal_code": "542171095"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "143 SCHOOL CREEK TRL",
            "city": "LUXEMBURG",
            "state": "WI",
            "postal_code": "542171095",
            "telephone_number": "920-845-5950"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FRED & MAMIE'S HOME, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-07-12",
        "last_updated": "2007-07-12",
        "status": "A",
        "authorized_official_last_name": "DEPEAU",
        "authorized_official_first_name": "SHARON",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "PRESIDENT/OWNER",
        "authorized_official_telephone_number": "920-845-5950"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "WI",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Samantha J Dawalt, DC
• Ann Marie Deprey, M.S., CCC-SLP
• Gina Enderby
• Elyse Marie Engebose, FNP-C
• Eye & Vision Clinics, S.C.
• Rey Anthony G Garibay, MD
• Amanda Haberli, RN
• Helping Hearts Assisted Living LLC
• Bonnie L Hert
• Alissa Katherine Heurkens

• Assisted Living Facility in Luxemburg, WI
• Providers in Luxemburg, 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 Jul 12, 2007; 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.