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KENOSHA SENIOR LIVING, INC.
NPI 1790169944
Assisted Living Facility in Kenosha, WI

Active since July 17, 2015CLIA 52D1105729 · Waiver
3109 30TH AVE, KENOSHA, WI 53144(262) 656-1795(262) 656-1875 Get Directions Write a Review

NPPES record last updated: June 11, 2025. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Jun 11, 2025, Jan 22, 2020 (2 updates tracked since 2020).

About Kenosha Senior Living, Inc. NPPES

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

KENOSHA SENIOR LIVING, INC. (NPI 1790169944), doing business as Kenosha Senior Living, is a healthcare organization registered as an assisted living facility in Kenosha, Wisconsin and active in the NPI registry since July 2015. The organization holds a CLIA Waiver certificate valid through September 27, 2027 and lists Amber L Tueller, Secretary, as its authorized official.

NPPES Registry Identity

NPI1790169944
Entity TypeOrganization
Primary Taxonomy310400000X
Legal Business NameKENOSHA SENIOR LIVING, INC.
Location Address3109 30TH AVEKenosha, WI 53144-1673
Mailing Address3109 30th AveKenosha, WI 53144-1673 · (262) 656-1795 · Fax (262) 656-1875
Phone(262) 656-1795
Fax(262) 656-1875
Organization SubpartNo
Authorized OfficialAmber L TuellerSecretary · (208) 207-2726
Enumeration DateJuly 17, 2015
Last NPPES UpdateJune 11, 20252 updates tracked since enumeration
NPPES CertifiedJune 11, 2025
✔ NPI 1790169944 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.
3109 30TH AVE, Kenosha, WI 53144
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Other Names 1

Doing Business AsKenosha Senior Living

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 52D1105729

Kenosha Senior Living · Kenosha, WI
Active · expires Sep 27, 2027
CLIA Number52D1105729
Laboratory TypeAssisted Living Facility
Certificate Effective DateSeptember 28, 2025
Certificate Expiration DateSeptember 27, 2027
Laboratory DirectorMelissa Koerber
Laboratory Phone(262) 656-1795
Laboratory LocationKenosha Senior Living3109 30th Ave, Kenosha, WI 53144
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MRS. AMANDA KAY KREUZER COTA
Occupational Therapy Assistant
3109 30TH AVE
KENOSHA, WI 53144
Kenosha County (262) 764-4225

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 Kenosha Senior Living, Inc.'s NPI number?

The NPI number for Kenosha Senior Living, Inc. is 1790169944. It was assigned to this organization in the NPPES registry on July 17, 2015. The provider is doing business as Kenosha Senior Living.

Where is Kenosha Senior Living, Inc. located?

Kenosha Senior Living, Inc. is located at 3109 30th Ave, Kenosha, WI 53144. The listed phone number is (262) 656-1795.

What is Kenosha Senior Living, Inc.'s specialty?

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

Does Kenosha Senior Living, Inc. hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 52D1105729) is associated with this NPI, valid through September 27, 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 Kenosha Senior Living, Inc. was last updated on June 11, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 13 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.