Kinnic Long Term Care Facility LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

3095 Issued in WI

Legal business name

KINNIC LONG TERM CARE FACILITY LLC

Practice address

1663 E Division St
River Falls, WI 54022-1571

Phone

(715) 426-6000

Fax

(715) 426-6007

NPI assigned

Sep 19, 2005

Organization subpart

No

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

Authorized official

Name

Mr. Dennis L Heyde

Title

President

Phone

(715) 726-9094

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Kinnic Long Term Care Doing business as

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

{
    "created_epoch": "1127088000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1093700734",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "345 FRENETTE DR",
            "city": "CHIPPEWA FALLS",
            "state": "WI",
            "postal_code": "547293372"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1663 E DIVISION ST",
            "city": "RIVER FALLS",
            "state": "WI",
            "postal_code": "540221571",
            "telephone_number": "715-426-6000",
            "fax_number": "715-426-6007"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KINNIC LONG TERM CARE FACILITY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-09-19",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "HEYDE",
        "authorized_official_first_name": "DENNIS",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "715-726-9094",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "WI",
            "license": "3095",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "20192800",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Kinnic Long Term Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Kent Howard Kittleson, P.T.
• Carrie Kleven, RN
• Timothy Dale Knotek, DDS
• Melissa J Kolb, D.C.
• Katelyn Kostick, DPT

• All providers in River Falls, WI
• Skilled Nursing 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.