Heatherlyn Assisted Living LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

Legal business name

HEATHERLYN ASSISTED LIVING LLC

Practice address

811 Robert St
Fort Atkinson, WI 53538-1140

Phone

(920) 397-1610

NPI assigned

Feb 9, 2020

Organization subpart

No

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

Authorized official

Name

Jhienelle Talethia Kistle

Title

Executive Director

Phone

(920) 397-1610

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1581206400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1581206400000",
    "number": "1972135838",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "327 E CLAY ST UNIT 19",
            "city": "WHITEWATER",
            "state": "WI",
            "postal_code": "531902077",
            "telephone_number": "920-397-1610"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "811 ROBERT ST",
            "city": "FORT ATKINSON",
            "state": "WI",
            "postal_code": "535381140",
            "telephone_number": "920-397-1610"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HEATHERLYN ASSISTED LIVING LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-02-09",
        "last_updated": "2020-02-09",
        "certification_date": "2020-02-09",
        "status": "A",
        "authorized_official_last_name": "KISTLE",
        "authorized_official_first_name": "JHIENELLE",
        "authorized_official_middle_name": "TALETHIA",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "920-397-1610"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 9, 2020; 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.