Edenbrook Meadows Assisted Living LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

Legal business name

EDENBROOK MEADOWS ASSISTED LIVING LLC

Practice address

154 S Pioneer Pkwy
Fond Du Lac, WI 54935-3848

Phone

(920) 921-3993

NPI assigned

Apr 8, 2022

Organization subpart

No

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

Authorized official

Name

Maxim Stesel, MANAGER

Title

Manager

Phone

(733) 825-3336

Specialties & licenses 1

Addresses

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": "1649376000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1649376000000",
    "number": "1740922095",
    "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": "177-382-5333"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "154 S PIONEER PKWY",
            "city": "FOND DU LAC",
            "state": "WI",
            "postal_code": "549353848",
            "telephone_number": "920-921-3993"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EDENBROOK MEADOWS ASSISTED LIVING LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-04-08",
        "last_updated": "2022-04-08",
        "certification_date": "2022-04-08",
        "status": "A",
        "authorized_official_last_name": "STESEL",
        "authorized_official_first_name": "MAXIM",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "733-825-3336",
        "authorized_official_credential": "MANAGER"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Assisted Living Facility in Fond Du Lac, WI
• Providers in Fond Du Lac, 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 Apr 8, 2022; 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.