Beaver Dam Al Operations LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

Legal business name

BEAVER DAM AL OPERATIONS LLC

Practice address

104 Fakes CT
Beaver Dam, WI 53916-2699

Phone

(773) 825-3336

NPI assigned

Dec 19, 2022

Last updated

Dec 19, 2022By 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

Anya Vistman

Title

GC

Phone

(773) 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": "1671408000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1671408000000",
    "number": "1790497907",
    "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": "763-439-0320"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "104 FAKES CT",
            "city": "BEAVER DAM",
            "state": "WI",
            "postal_code": "539162699",
            "telephone_number": "773-825-3336"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "129 Evergreen Cir",
            "address_purpose": "LOCATION",
            "city": "Beaver Dam",
            "state": "WI",
            "postal_code": "539163512",
            "country_code": "US",
            "telephone_number": "773-825-3336",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "BEAVER DAM AL OPERATIONS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-12-19",
        "last_updated": "2022-12-19",
        "certification_date": "2022-12-19",
        "status": "A",
        "authorized_official_last_name": "VISTMAN",
        "authorized_official_first_name": "ANYA",
        "authorized_official_title_or_position": "GC",
        "authorized_official_telephone_number": "773-825-3336"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Michelle J Bartzen, PA-C
• Seth Mathew Barudin, MD
• Susan Marie Baumann, OTR
• Timothy J Baumann, OTA
• Devyn Beaugh, PHARM.D.
• Beaver Dam Assisted Living, LLC (Beaver Dam Assisted Living and Memory Care)
• Beaver Dam Community Hospitals Inc (Marshfield Medical Center - Beaver Dam)
• Beaver Dam Community Hospitals Inc ((inactive) Marshfield Medical Center - Beaver Dam Hospitalist Group)
• Beaver Dam Community Hospitals Inc (Marshfield Medical Center - Beaver Dam Pharmacy (Part B Immunization))
• Beaver Dam Community Hospitals Inc ((Inactive) Marshfield Medical Center - Beaver Dam Sleep Center)

• Assisted Living Facility in Beaver Dam, WI
• Providers in Beaver Dam, 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 Dec 19, 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.