Benedictine Living Community of Spooner

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

Legal business name

BENEDICTINE LIVING COMMUNITY OF SPOONER

Practice address

510 First Street
Spooner, WI 54801

Phone

(715) 635-1412

Fax

(715) 635-7498

NPI assigned

Jun 22, 2011

Last updated

Jun 22, 2011By 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

Mr. Len Meysembourg

Title

Administrator/Ceo

Phone

(715) 635-1420

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1308700800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1308700800000",
    "number": "1073809620",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "510 FIRST STREET",
            "city": "SPOONER",
            "state": "WI",
            "postal_code": "54801",
            "telephone_number": "715-635-1412",
            "fax_number": "715-635-7498"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "510 FIRST STREET",
            "city": "SPOONER",
            "state": "WI",
            "postal_code": "54801",
            "telephone_number": "715-635-1412",
            "fax_number": "715-635-7498"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BENEDICTINE LIVING COMMUNITY OF SPOONER",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-06-22",
        "last_updated": "2011-06-22",
        "status": "A",
        "authorized_official_last_name": "MEYSEMBOURG",
        "authorized_official_first_name": "LEN",
        "authorized_official_title_or_position": "ADMINISTRATOR/CEO",
        "authorized_official_telephone_number": "715-635-1420",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Aurora Community Counseling Employee Support and Services, Inc.
• Dellin Richard Bakkum, DDS
• Adam James Barg, PT
• Holly Kay Barrett, APRN, CNP
• Megan R Bauer, SAC-IT
• Laura Lynne Boehlke-Bray, M.D.
• Beverly J Bohac, MD
• Sydnee Jolyn Borelli, COTA
• Bruce Edward Bray
• James Ballantine Brown Jr., MD

• Skilled Nursing Facility in Spooner, WI
• Providers in Spooner, 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 Jun 22, 2011; 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.