Sumac Residential LLC

Primary specialty

Intellectual and/or Developmental Disabilities Residential Treatment FacilityTaxonomy code 320600000X

Legal business name

SUMAC RESIDENTIAL LLC

Doing business as

Blue Jay Assisted Living

Practice address

723 B Blue Jay Lane
Hudson, WI 54016

Phone

(715) 255-0466

NPI assigned

Sep 10, 2010

Last updated

Sep 10, 2010By 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

Mr. Timothy Rusk

Title

Owner

Phone

(715) 255-0466

Specialties & licenses 1

Addresses

Other names 1

• Blue Jay Assisted Living Doing business as

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

{
    "created_epoch": "1284076800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1284076800000",
    "number": "1912214966",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "723B BLUE JAY LN",
            "city": "HUDSON",
            "state": "WI",
            "postal_code": "540167695",
            "telephone_number": "715-255-0466"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "723 B BLUE JAY LANE",
            "city": "HUDSON",
            "state": "WI",
            "postal_code": "54016",
            "telephone_number": "715-255-0466"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUMAC RESIDENTIAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-09-10",
        "last_updated": "2010-09-10",
        "status": "A",
        "authorized_official_last_name": "RUSK",
        "authorized_official_first_name": "TIMOTHY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "715-255-0466",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "320600000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "WI",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Blue Jay Assisted Living",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Nicole Streif, M.S. CCC-SLP
• Terry Strodthoff, COTA
• Cindy L Stuhmer, CSAC, ICS, LCSW
• Barbara J Suick
• Lucy Sullivan
• Summit Unity LLC
• Savannah Sund
• Leslie Winter Surbeck, MD
• Jonathan L Susa I, D.O.
• Mya Sutton

• Intellectual and/or Developmental Disabilities Residential Treatment Facility in Hudson, WI
• Providers in Hudson, WI by specialty
• Intellectual and/or Developmental Disabilities Residential Treatment Facility in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 10, 2010; 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.