LAKESHORE MANOR MEMORY CARE LLC
NPI 1699350397
Nursing Home Administrator in Oshkosh, WI
NPI Status: Active since March 14, 2021
Contact Information
711 BAY SHORE DR
OSHKOSH, WI
ZIP 54901
Phone: (920) 393-3871
- Organization
- Nursing Home Administrator
- CLIA Number: 52D1089104
- CLIA Cert. Type: Assisted Living Facility
- CLIA Exp. Date: 04-21-2027
About LAKESHORE MANOR MEMORY CARE LLC
This page provides the complete NPI Profile along with additional information for Lakeshore Manor Memory Care Llc, a provider established in Oshkosh, Wisconsin operating as a Nursing Home Administrator. The healthcare provider is registered in the NPI registry with number 1699350397 assigned on March 2021. The practitioner's primary taxonomy code is 376G00000X. The provider is registered as an organization and their NPI record was last updated 5 years ago. Lakeshore Manor Memory Care Llc operates as a Multi-Specialty Group with one or more individual practitioners, who practice different areas of specialization. The authorized official of this NPI record is Anya Vistman (Corp Counsel)
- NPI
- 1699350397
- Provider Name
- LAKESHORE MANOR MEMORY CARE LLC
- Entity Type
- Organization
- Location Address
- 711 BAY SHORE DR OSHKOSH, WI 54901
- Location Phone
- (920) 393-3871
- Mailing Address
- 8170 MCCORMICK BLVD STE 112 SKOKIE, IL 60076
- Mailing Phone
- (773) 819-2190
- Is Sole Proprietor?
- No
- Is Organization Subpart?
- No
- Enumeration Date
- 03-14-2021
- Last Update Date
- 03-14-2021
- Code Navigator
Location Map
Specialty - Primary Taxonomy
The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
- Classification
Nursing Home Administrator
- Taxonomy Code
- 376G00000X
- Type
- Nursing Service Related Providers
- Taxonomy Description
- An individual, often licensed by the state, who is responsible for the management of a nursing home.
Group Taxonomy 193200000X MULTI-SPECIALTY GROUP
This provider is a business group of one or more individual practitioners, who practice with different areas of specialization.
CLIA Information
The Clinical Laboratory Improvement Amendments (CLIA) of 1988 applies to facilities or sites that test human specimens for health assessment or to diagnose, prevent, or treat disease. The CLIA Program sets standards for clinical laboratory testing and issues certificates. The NPI / CLIA crosswalk information for this NPI number is:
- CLIA Number
- 52D1089104
- Facility Type
- Assisted Living Facility
- Certificate Effective Date
- April 22, 2025
- Certificate Expiration Date
- April 21, 2027
- Laboratory Director
- KRYSTAL BITTNER
- Certificate Type
- Certificate of Waiver
- Certificate Type Description
- This CLIA certificate is issued to Lakeshore Manor Memory Care Llc to perform only waived tests. CLIA defines waived tests as simple tests with a low risk for an incorrect result. Waived tests include certain tests listed in CLIA regulations, tests cleared by the FDA for home use and tests approved by the FDA for waived status and that meet CLIA waiver criteria.
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NPI NPI Number Validation
How NPI Validation Works
The NPI validation process uses the ISO-standard Luhn algorithm, a mathematical "handshake", to ensure that a provider's 10-digit ID is authentic and free of common typing errors.
To verify the NPI 1699350397, we treat the final digit (7) as the Check Digit—the target answer we need to reach. The process begins by taking the first nine digits and adding a constant value of 24, which accounts for the "80840" prefix required for all U.S. health identifiers. We then double every other digit starting from the right and sum the individual digits of those results together. For this specific NPI, that total comes to 73. The final step is to find the difference between that total and the next multiple of ten (80 - 73 = 7).
Digit-by-digit view
Use the first nine digits for the calculation. Starting from the right, double every other digit. The last digit is the check digit and is not part of the calculation.
Step 1: Double every other digit from the right
Starting with the rightmost digit of the first nine digits, double every other value. If doubling creates a two-digit number, add those digits together.
Step 2: Add all digits plus the NPI constant
Add the transformed values, the unchanged digits, and the constant 24.
Step 3: Find the amount needed to reach the next multiple of 10
The next multiple of ten after 73 is 80. The difference is the calculated check digit.
Other Providers at the Same Location
The following 1 provider is registered at the same or a nearby location.
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1699350397, enumerated as an "organization" on March 14, 2021.
The provider is located at 711 BAY SHORE DR OSHKOSH, WI 54901 and the phone number is (920) 393-3871.
Nursing Home Administrator with taxonomy code 376G00000X.
