Petersen Health Care of Wi, Inc.

Primary specialty

Intellectual and/or Developmental Disabilities Residential Treatment FacilityTaxonomy code 320600000X

License

2752 Issued in WI

Legal business name

PETERSEN HEALTH CARE OF WI, INC.

Doing business as

Horizons Unlimited

Practice address

902 Boyce Dr
Rhinelander, WI 54501-3835

Phone

(715) 365-6818

Fax

(715) 365-6770

NPI assigned

Sep 15, 2005

Last updated

Aug 22, 2020By 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. Terry L Friese, NHA

Title

President/Ceo

Phone

(715) 365-6900

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Horizons Unlimited Doing business as

Tax ID family

Friendly Village2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

• Petersen Health Care of Wi, Inc.

  dba Friendly Village

  • Skilled Nursing Facility
  • Rhinelander, WI
  • NPI 1659373348
  NPD tax ID

Locations

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

{
    "created_epoch": "1126742400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1093700098",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "902 BOYCE DRIVE",
            "address_2": "P.O. BOX 857",
            "city": "RHINELANDER",
            "state": "WI",
            "postal_code": "545010857",
            "telephone_number": "715-365-6818",
            "fax_number": "715-365-6770"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "902 BOYCE DR",
            "city": "RHINELANDER",
            "state": "WI",
            "postal_code": "545013835",
            "telephone_number": "715-365-6818",
            "fax_number": "715-365-6770"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PETERSEN HEALTH CARE OF WI, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-09-15",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "FRIESE",
        "authorized_official_first_name": "TERRY",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "715-365-6900",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "NHA"
    },
    "taxonomies": [
        {
            "code": "320600000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "WI",
            "license": "2752",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "20114900",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Horizons Unlimited",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Heather A Pelock Hjelle, APNP BC
• Danielle Perner, DPT
• James P Perra
• Tammery M Perry, APNP
• Petco Wellness LLC (Doctors Foster and Smith Pharmacy)
• Petersen Health Care of Wi, Inc. (Friendly Village)
• Petersen Health Care of Wi, Inc. (Taylor Park Health Care and Rehabilitation Center)
• Petersen Rehabilitation Center, Inc. (Horizons Unlimited)
• Nicole Marie Peterson, FNP-C
• Shawn Ann Pflugardt, PSY.D.

• Intellectual and/or Developmental Disabilities Residential Treatment Facility in Rhinelander, WI
• Providers in Rhinelander, WI by specialty
• Intellectual and/or Developmental Disabilities Residential Treatment Facility in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.