MORAINE RIDGE LLC
NPI 1053282020
Assisted Living Facility in Green Bay, WI

Q: What is Moraine Ridge LLC's NPI number?

The NPI number for Moraine Ridge LLC is 1053282020. It was assigned to this organization in the NPPES registry on September 15, 2025.

Q: What is Moraine Ridge LLC's specialty?

The primary specialty registered for this NPI is Assisted Living Facility with taxonomy code 310400000X.

Q: When was this NPI record last updated?

The NPPES record for Moraine Ridge LLC was last updated on September 15, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 10 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since September 15, 2025CLIA 52D1106004 · Waiver

2929 SAINT ANTHONY DR, GREEN BAY, WI 54311(920) 468-3111(920) 593-1462 Get Directions Write a Review

NPPES record last updated: September 15, 2025. Verified against the NPPES registry weekly; last sync: August 09, 2026.

On this page

About Moraine Ridge Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MORAINE RIDGE LLC (NPI 1053282020) is a healthcare organization registered as an assisted living facility in Green Bay, Wisconsin and active in the NPI registry since September 2025. The organization holds a CLIA Waiver certificate valid through October 1, 2027 and lists Lorrie Ann Ryczek, Regional Director, as its authorized official.

NPPES Registry Identity

NPI1053282020

Entity TypeOrganization

Primary Taxonomy310400000X

Legal Business NameMORAINE RIDGE LLC

Location Address2929 SAINT ANTHONY DRGreen Bay, WI 54311-5878

Mailing Address2929 Saint Anthony DrGreen Bay, WI 54311-5878 · (920) 468-3111 · Fax (920) 593-1462

Phone(920) 468-3111

Fax(920) 593-1462

Organization SubpartYes

Authorized OfficialLorrie Ann RyczekRegional Director · (920) 468-3111

Enumeration DateSeptember 15, 2025

NPPES CertifiedSeptember 15, 2025

✔ NPI 1053282020 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyAssisted Living FacilityNursing & Custodial Care Facilities

Taxonomy Code310400000X

Definition

A facility providing supportive services to individuals who can function independently in most areas of activity, but need assistance and/or monitoring to assure safety and well being.

2929 SAINT ANTHONY DR, Green Bay, WI 54311

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CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 52D1106004

Moraine Ridge Assisted Living · Green Bay, WI

Active · expires Oct 1, 2027

CLIA Number52D1106004

Laboratory TypeAssisted Living Facility

Certificate Effective DateOctober 2, 2025

Certificate Expiration DateOctober 1, 2027

Laboratory DirectorDouglas Hennig

Laboratory Phone(920) 468-3111

Laboratory LocationMoraine Ridge Assisted Living2929 St Anthony Dr Ste 101, Green Bay, WI 54302

CLIA data matches this NPI record on: Name Phone

This certificate is issued to a laboratory to perform only waived tests.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Moraine Ridge LLC's NPI number?

The NPI number for Moraine Ridge LLC is 1053282020. It was assigned to this organization in the NPPES registry on September 15, 2025.

Where is Moraine Ridge LLC located?

Moraine Ridge LLC is located at 2929 Saint Anthony Dr, Green Bay, WI 54311. The listed phone number is (920) 468-3111.

What is Moraine Ridge LLC's specialty?

The primary specialty registered for this NPI is Assisted Living Facility with taxonomy code 310400000X.

Does Moraine Ridge LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 52D1106004) is associated with this NPI, valid through October 1, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Moraine Ridge LLC was last updated on September 15, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 10 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.