KETTLE PARK SENIOR LIVING INC
NPI 1649821661
Assisted Living Facility in Stoughton, WI
About Kettle Park Senior Living Inc NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
KETTLE PARK SENIOR LIVING INC (NPI 1649821661), doing business as Kettle Park Senior Living, is a healthcare organization registered as an assisted living facility in Stoughton, Wisconsin and active in the NPI registry since September 2019. The organization holds a CLIA Waiver certificate valid through August 20, 2027 and lists Tricia Lies, Director Of Financial Services, as its authorized official.
NPPES Registry Identity
Specialties & Licenses
Other Names 1
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 52D2170879
Kettle Park Senior Living · Stoughton, WIFrequently 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 Kettle Park Senior Living Inc's NPI number?
The NPI number for Kettle Park Senior Living Inc is 1649821661. It was assigned to this organization in the NPPES registry on September 20, 2019. The provider is doing business as Kettle Park Senior Living.
Where is Kettle Park Senior Living Inc located?
Kettle Park Senior Living Inc is located at 2600 Jackson St, Stoughton, WI 53589. The listed phone number is (608) 579-5601.
What is Kettle Park Senior Living Inc's specialty?
The primary specialty registered for this NPI is Assisted Living Facility with taxonomy code 310400000X.
Does Kettle Park Senior Living Inc hold a CLIA laboratory certificate?
Yes. A Certificate of Waiver (number 52D2170879) is associated with this NPI, valid through August 20, 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 Kettle Park Senior Living Inc was last updated on September 20, 2019. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 7 years 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.
# Kettle Park Senior Living Inc · NPI 1649821661
Assisted Living Facility organization in Stoughton, Wisconsin. Organization record, active in the CMS NPPES registry since September 20, 2019.
## Identity
- **NPI:** 1649821661 (Entity type: Organization)
- **Enumerated:** September 20, 2019
- **Primary specialty:** Assisted Living Facility · taxonomy 310400000X
- **Also known as:** Kettle Park Senior Living (Doing Business As)
- **Organization subpart:** No
- **Authorized official:** Tricia Lies, DIRECTOR OF FINANCIAL SERVICES
## Practice location
- **Address:** 2600 JACKSON ST, Stoughton, WI 53589-9142
- **Phone:** (608) 579-5601
## Record status
- **NPPES last updated:** September 20, 2019
- **CLIA laboratory certificates:** 1 on file
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Source: [NPI Profile](https://npiprofile.com/npi/1649821661) · Data from the CMS NPPES public registry.