Kiwanis Manor Inc

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

2548 Issued in WI

Legal business name

KIWANIS MANOR INC

Practice address

3271 North St
East Troy, WI 53120-1147

Phone

(262) 642-3995

Fax

(262) 642-3930

NPI assigned

Jul 7, 2005

Organization subpart

No

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

Authorized official

Name

Ms. Lynn Senecal

Title

Administrator

Phone

(262) 642-3995

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1120694400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1215934997",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3271 NORTH ST",
            "city": "EAST TROY",
            "state": "WI",
            "postal_code": "531201147",
            "telephone_number": "262-642-3995",
            "fax_number": "262-642-3930"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3271 NORTH ST",
            "city": "EAST TROY",
            "state": "WI",
            "postal_code": "531201147",
            "telephone_number": "262-642-3995",
            "fax_number": "262-642-3930"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KIWANIS MANOR INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-07-07",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "SENECAL",
        "authorized_official_first_name": "LYNN",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "262-642-3995",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "WI",
            "license": "2548",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "20101100",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Skilled Nursing Facility in East Troy, WI
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• 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.