County of Shawano

Organization Active NPI Skilled Nursing Facility · Shawano, WI

NPI 1124028519 · NPPES record last updated Sep 10, 2007

Key facts

NPI
1124028519
Entity type
Organization (NPI type 2)
Primary specialty
Skilled Nursing Facility 314000000X
License
2579 (WI)
Legal business name
COUNTY OF SHAWANO
Practice address
N4231 State Highway 22
Shawano, WI 54166-6130
Phone
(715) 526-3158
Fax
(715) 526-6823
NPI assigned
Jul 28, 2005
Organization subpart
No

Authorized official

Name
Mrs. Debbra R Kessen
Title
Accountant/Controller
Phone
(715) 526-3158

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

National Provider Directory

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X 2579 WI Yes

Addresses

Primary practice location

N4231 State Highway 22
Shawano, WI 54166-6130

Mailing address

N4231 State Highway 22
Shawano, WI 54166-6130
Phone (715) 526-3158

Other identifiers

IdentifierTypeStateIssuer
20160600MedicaidWI

Other names

  • Maple Lane Health Care Center Doing business as

Other providers in Shawano, WI

All providers in Shawano, WI · Skilled Nursing Facility in Wisconsin

Sources for this page

Verify at the official NPI Registry.