CHP SHOREWOOD WI TENANT CORP NPI 1164965257

NPI Information

  • NPI: 1164965257
  • Provider Name: CHP SHOREWOOD WI TENANT CORP
  • Classification: Assisted Living Facility - 310400000X
  • Entity Type: Organization
  • Doing Business As: HARBORCHASE OF SHOREWOOD
  • CLIA Number: 52D2103655
  • Address: 1111 E CAPITOL DR
    SHOREWOOD, WI
    ZIP 53211
  • Phone: (414) 436-0311

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NPI Details

CHP SHOREWOOD WI TENANT CORP is an assisted living facility in Shorewood, WI. The provider is 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. CHP SHOREWOOD WI TENANT CORP NPI is 1164965257. The provider is registered as an organization entity type.
The provider Is Doing Business As Harborchase Of Shorewood.

The provider's business location address is:

1111 E CAPITOL DR
SHOREWOOD, WI
ZIP 53211-810
Phone: (414) 436-0311
Fax: (414) 436-0312

The provider's authorized official is Thomas Mitchell .
The authorized official title is Cfo Of Manager and has the following contact phone number (772) 492-5002.

The CLIA number assigned to this NPI record is 52D2103655 - assisted living facility with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 11/22/2016 and was last updated on 11/22/2016.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1310400000XAssisted Living Facility0015905WISCONSINYes

What is NPI?

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This page was last updated on: 3/30/2025

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