LAKEWOOD ASSISTED LIVING, LLC - NPI 1235458894 - Assisted Living Facility in Lakewood, WI

Q: What is Lakewood Assisted Living, LLC's NPI number?

The NPI number for Lakewood Assisted Living, LLC is 1235458894. It was assigned to this organization in the NPPES registry on May 21, 2010.

Q: What is Lakewood Assisted Living, LLC's specialty?

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

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About Lakewood Assisted Living, Llc NPPES

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

LAKEWOOD ASSISTED LIVING, LLC (NPI 1235458894) is a healthcare organization registered as an assisted living facility in Lakewood, Wisconsin and active in the NPI registry since May 2010. The organization holds a CLIA Waiver certificate valid through October 15, 2026 and lists Katherine R Tegen, Manager, as its authorized official.

NPPES Registry Identity

NPI1235458894

Entity TypeOrganization

Primary Taxonomy310400000X

Legal Business NameLAKEWOOD ASSISTED LIVING, LLC

Location Address17185 FLYNN LNLakewood, WI 54138-9593

Mailing AddressW3124 Van Roy RdAppleton, WI 54915-3982 · (920) 574-3833 · Fax (920) 574-3850

Phone(715) 276-1680

Organization SubpartNo

Authorized OfficialKatherine R TegenManager · (920) 378-5839

Enumeration DateMay 21, 2010

✔ NPI 1235458894 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.

17185 FLYNN LN, Lakewood, WI 54138

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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 52D2005748

Lakewood Assisted Living · Lakewood, WI

Active · expires Oct 15, 2026

CLIA Number52D2005748

Laboratory TypeAssisted Living Facility

Certificate Effective DateOctober 16, 2024

Certificate Expiration DateOctober 15, 2026

Laboratory DirectorMs. Jackie Dey

Laboratory Phone(715) 276-1680

Laboratory LocationLakewood Assisted Living17185 Flynn Ln, Lakewood, WI 54138

CLIA data matches this NPI record on: Address 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 Lakewood Assisted Living, LLC's NPI number?

The NPI number for Lakewood Assisted Living, LLC is 1235458894. It was assigned to this organization in the NPPES registry on May 21, 2010.

Where is Lakewood Assisted Living, LLC located?

Lakewood Assisted Living, LLC is located at 17185 Flynn Ln, Lakewood, WI 54138. The listed phone number is (715) 276-1680.

What is Lakewood Assisted Living, LLC's specialty?

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

Does Lakewood Assisted Living, LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 52D2005748) is associated with this NPI, valid through October 15, 2026. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Lakewood Assisted Living, LLC was last updated on May 21, 2010. NPI Profile syncs with the weekly NPPES data releases published by CMS.