NPIMap

Organization Active NPI

Lincoln Lutheran Community Care Corporation

  • Skilled Nursing Facility
  • Racine, WI
National Provider Identifier
1871677963
Registry record updated Feb 16, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
3179 Issued in WI
Legal business name
LINCOLN LUTHERAN COMMUNITY CARE CORPORATION
Doing business as
Becker Shoop Center
Practice address
6101 16TH Street
Racine, WI 53406
Phone
(262) 637-7486
Fax
(262) 633-3045
NPI assigned
Oct 25, 2006
Organization subpart
Yes
Parent organization
LINCOLN LUTHERAN HOME OF RACINE INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Feb 16, 2012

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

Authorized official

Name
Fred Richard Bova Jr., CPA
Title
Chief Financial Officer
Phone
(262) 898-2701

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X 3179 WI Primary

Addresses

Primary practice location

6101 16TH Street
Racine, WI 53406

Mailing address

2000 Domanik Drive
Racine, WI 53404
Phone (262) 633-0500

Other identifiers 1

IdentifierTypeStateIssuer
20177300MedicaidWI

Other names 1

  • Becker Shoop Center Doing business as

National Provider Directory

National Provider Directory
Part of
Lincoln Lutheran of Racine

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

NPI Registry JSON

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

{
    "created_epoch": "1161734400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1329350400000",
    "number": "1871677963",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2000 DOMANIK DRIVE",
            "city": "RACINE",
            "state": "WI",
            "postal_code": "53404",
            "telephone_number": "262-633-0500",
            "fax_number": "262-633-3045"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6101 16TH STREET",
            "city": "RACINE",
            "state": "WI",
            "postal_code": "53406",
            "telephone_number": "262-637-7486",
            "fax_number": "262-633-3045"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LINCOLN LUTHERAN COMMUNITY CARE CORPORATION",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "LINCOLN LUTHERAN HOME OF RACINE INC.",
        "enumeration_date": "2006-10-25",
        "last_updated": "2012-02-16",
        "status": "A",
        "authorized_official_last_name": "BOVA",
        "authorized_official_first_name": "FRED",
        "authorized_official_middle_name": "RICHARD",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "262-898-2701",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "CPA"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "WI",
            "license": "3179",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "20177300",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Becker Shoop Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Racine, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 16, 2012; 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.