NPIMap

Organization Active NPI

Extendicare Homes, Inc.

Doing business as Salyersville Adult Day Center

  • Skilled Nursing Facility
  • Salyersville, KY
National Provider Identifier
1124190566
Registry record updated Jun 11, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
EXTENDICARE HOMES, INC.
Doing business as
Salyersville Adult Day Center
Practice address
571 Parkway Dr
Salyersville, KY 41465-9248
Phone
(606) 349-6161
Fax
(606) 349-4784
NPI assigned
Nov 14, 2006
Last updated
Jun 11, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 11, 2008

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

Authorized official

Name
Donna Jo Maassen
Title
Director of Compliance
Phone
(414) 908-8119

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X NU Primary

Addresses

Primary practice location

571 Parkway Dr
Salyersville, KY 41465-9248

Mailing address

111 W Michigan St
Milwaukee, WI 53203-2903
Phone (414) 908-8119

Other identifiers 1

IdentifierTypeStateIssuer
43001775MedicaidKY

Other names 1

  • Salyersville Adult Day Center Doing business as

National Provider Directory

National Provider Directory
Tax ID family
First Coast Health and14 organizations share this tax ID, including this one

Other organizations with this tax ID 13

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

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1163462400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1213142400000",
    "number": "1124190566",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "111 W MICHIGAN ST",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532032903",
            "telephone_number": "414-908-8119",
            "fax_number": "414-908-7105"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "571 PARKWAY DR",
            "city": "SALYERSVILLE",
            "state": "KY",
            "postal_code": "414659248",
            "telephone_number": "606-349-6161",
            "fax_number": "606-349-4784"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EXTENDICARE HOMES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-14",
        "last_updated": "2008-06-11",
        "status": "A",
        "authorized_official_last_name": "MAASSEN",
        "authorized_official_first_name": "DONNA",
        "authorized_official_middle_name": "JO",
        "authorized_official_title_or_position": "DIRECTOR OF COMPLIANCE",
        "authorized_official_telephone_number": "414-908-8119"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "43001775",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Salyersville Adult Day Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Salyersville, KY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2008; 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.