Provider Demographics
NPI:1366437006
Name:PEPIN OPERATOR, LLC
Entity type:Organization
Organization Name:PEPIN OPERATOR, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO & PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STUART
Authorized Official - Middle Name:
Authorized Official - Last Name:LINDEMEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-280-1333
Mailing Address - Street 1:1110 SECOND STREET
Mailing Address - Street 2:
Mailing Address - City:PEPIN
Mailing Address - State:WI
Mailing Address - Zip Code:54759-9658
Mailing Address - Country:US
Mailing Address - Phone:715-442-4811
Mailing Address - Fax:715-442-2904
Practice Address - Street 1:1110 2ND ST
Practice Address - Street 2:
Practice Address - City:PEPIN
Practice Address - State:WI
Practice Address - Zip Code:54759-9658
Practice Address - Country:US
Practice Address - Phone:715-442-4811
Practice Address - Fax:715-442-2904
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-19
Last Update Date:2014-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3165314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI20189800Medicaid
WI20189800Medicaid