Kenosha Senior Living, Inc.

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

Legal business name

KENOSHA SENIOR LIVING, INC.

Doing business as

Kenosha Senior Living

Practice address

3109 30TH Ave
Kenosha, WI 53144-1673

Phone

(262) 656-1795

Fax

(262) 656-1875

NPI assigned

Jul 17, 2015

Organization subpart

No

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

Authorized official

Name

Amber L Tueller

Title

Secretary

Phone

(208) 207-2726

Specialties & licenses 1

Addresses

Other names 1

• Kenosha 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": "1437091200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1749600000000",
    "number": "1790169944",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3109 30TH AVE",
            "city": "KENOSHA",
            "state": "WI",
            "postal_code": "531441673",
            "telephone_number": "262-656-1795",
            "fax_number": "262-656-1875"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3109 30TH AVE",
            "city": "KENOSHA",
            "state": "WI",
            "postal_code": "531441673",
            "telephone_number": "262-656-1795",
            "fax_number": "262-656-1875"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KENOSHA SENIOR LIVING, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-07-17",
        "last_updated": "2025-06-11",
        "certification_date": "2025-06-11",
        "status": "A",
        "authorized_official_last_name": "TUELLER",
        "authorized_official_first_name": "AMBER",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "SECRETARY",
        "authorized_official_telephone_number": "208-207-2726"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Kenosha Senior Living",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Kenosha Senior Living",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Assisted Living Facility in Kenosha, WI
• Providers in Kenosha, 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 Jun 11, 2025; 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.