Basic Information
| Provider Information | |||||||||
| NPI: | 1851644470 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | NUGLEN, LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | SEVEN OAKS | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7257 N LINCOLN AVE | ||||||||
| Address2: | |||||||||
| City: | LINCOLNWOOD | ||||||||
| State: | IL | ||||||||
| PostalCode: | 607121810 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8479332600 | ||||||||
| FaxNumber: | 8477450915 | ||||||||
| Practice Location | |||||||||
| Address1: | 6263 N GREEN BAY AVE | ||||||||
| Address2: | |||||||||
| City: | GLENDALE | ||||||||
| State: | WI | ||||||||
| PostalCode: | 532093823 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4143510543 | ||||||||
| FaxNumber: | 4143517977 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/19/2012 | ||||||||
| LastUpdateDate: | 10/19/2012 | ||||||||
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| AuthorizedOfficialLastName: | HARTMAN | ||||||||
| AuthorizedOfficialFirstName: | DAVID | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 8479332600 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | WI | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
No ID Information.