Sheboygan Senior Community

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

1575-19 Issued in WI

Legal business name

SHEBOYGAN SENIOR COMMUNITY

Practice address

1702 29TH St
Two Rivers, WI 54241-2010

Phone

(920) 242-4727

NPI assigned

Apr 15, 2013

Last updated

Apr 15, 2013By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Amy Van Ruden, OTR

Title

Reginal Manager

Phone

(242) 939-5296

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Kindred Other name

Tax ID family

Kindred3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

• Sheboygan Senior Com

  • Skilled Nursing Facility
  • Random Lake, WI
  • NPI 1356784888
  NPD tax ID
• Sheboygan Senior Community

  • Skilled Nursing Facility
  • Reedsville, WI
  • NPI 1609219195
  NPD tax ID

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1365984000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1365984000000",
    "number": "1023451523",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1702 29TH ST",
            "city": "TWO RIVERS",
            "state": "WI",
            "postal_code": "542412010"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1702 29TH ST",
            "city": "TWO RIVERS",
            "state": "WI",
            "postal_code": "542412010",
            "telephone_number": "920-242-4727"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHEBOYGAN SENIOR COMMUNITY",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-04-15",
        "last_updated": "2013-04-15",
        "status": "A",
        "authorized_official_last_name": "VAN RUDEN",
        "authorized_official_first_name": "AMY",
        "authorized_official_title_or_position": "REGINAL MANAGER",
        "authorized_official_telephone_number": "242-939-5296",
        "authorized_official_credential": "OTR"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "WI",
            "license": "1575-19",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "526538",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Kindred",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Katie Lynn Schroeder, PHARM.D., R.PH.
• Karen A. Schultz, M.S.P.T.
• Martha Schwobe
• Radhika Sharma, M.D.
• Rajesh Sharma, MD
• Valerie Jean Shepperd, MS, CCC-SLP
• Tracy L Sherman, M.D.
• Christopher John Simons, CHRISTOPHER SIMONS
• Anna Smith, FNP-C
• Brooke Kristen Smith

• Skilled Nursing Facility in Two Rivers, WI
• Providers in Two Rivers, WI by specialty
• Skilled Nursing Facility in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 15, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.