Basic Information
Provider Information
NPI: 1366844748
EntityType: 2
ReplacementNPI:  
OrganizationName: BROOKDALE SENIOR LIVING COMMUNITIES, INC.
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
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Credential:  
OtherOrganizationName: WYNWOOD OF MADISON WEST
OtherOrganizationType: 3
OtherLastName:  
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OtherMiddleName:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 6737 W WASHINGTON ST
Address2: SUITE 2300
City: MILWAUKEE
State: WI
PostalCode: 532145647
CountryCode: US
TelephoneNumber:  
FaxNumber:  
Practice Location
Address1: 413 S YELLOWSTONE DR
Address2:  
City: MADISON
State: WI
PostalCode: 537191042
CountryCode: US
TelephoneNumber: 6082771010
FaxNumber:  
Other Information
ProviderEnumerationDate: 09/17/2014
LastUpdateDate: 09/17/2014
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: OHLENDORF
AuthorizedOfficialFirstName: MARK
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition: CFO
AuthorizedOfficialTelephone: 4149185000
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
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AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
310400000X  Y Nursing & Custodial Care FacilitiesAssisted Living Facility 

No ID Information.


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