Provider Demographics
NPI:1447028261
Name:DIMENSIONS LIVING GREEN BAY, LLC
Entity type:Organization
Organization Name:DIMENSIONS LIVING GREEN BAY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AMBER
Authorized Official - Middle Name:
Authorized Official - Last Name:ROGOTZKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:763-537-5700
Mailing Address - Street 1:246 BERGER ST
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54302-3856
Mailing Address - Country:US
Mailing Address - Phone:920-468-9174
Mailing Address - Fax:920-468-9176
Practice Address - Street 1:246 BERGER ST
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54302-3856
Practice Address - Country:US
Practice Address - Phone:920-468-9174
Practice Address - Fax:920-468-9176
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-12
Last Update Date:2023-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility