Manor Care of Shawano Wi LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

3175 Issued in WI

Legal business name

MANOR CARE OF SHAWANO WI LLC

Doing business as

ManorCare Health Services - Shawano

Practice address

1436 S Lincoln St
Shawano, WI 54166-3427

Phone

(715) 526-6111

Fax

(715) 524-5708

NPI assigned

May 27, 2006

Last updated

Feb 8, 2008By 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. Barry A. Lazarus

Title

Vice President-Reimbursement

Phone

(419) 252-5541

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• ManorCare Health Services - Shawano Doing business as

Locations

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

{
    "created_epoch": "1148688000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1202428800000",
    "number": "1215984307",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "333 N SUMMIT ST",
            "address_2": "4TH FLOOR ATTN BARRY LAZARUS",
            "city": "TOLEDO",
            "state": "OH",
            "postal_code": "436041531",
            "telephone_number": "419-252-5541",
            "fax_number": "419-252-5548"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1436 S LINCOLN ST",
            "city": "SHAWANO",
            "state": "WI",
            "postal_code": "541663427",
            "telephone_number": "715-526-6111",
            "fax_number": "715-524-5708"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MANOR CARE OF SHAWANO WI LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-27",
        "last_updated": "2008-02-08",
        "status": "A",
        "authorized_official_last_name": "LAZARUS",
        "authorized_official_first_name": "BARRY",
        "authorized_official_middle_name": "A.",
        "authorized_official_title_or_position": "VICE PRESIDENT-REIMBURSEMENT",
        "authorized_official_telephone_number": "419-252-5541",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "WI",
            "license": "3175",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "20200500",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ManorCare Health Services - Shawano",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• May Kaying Lor
• Adrienne Luebke, PHARMD
• Kelly Ann Maas, MSE, LPC, SAS
• Kelly M Mackowski, APNP
• Janson A Mancheski, OD
• Paul S Mantz, DDS
• Maple Lane Health & Rehabilitation Center LLC (D/B/a Atrium Post Acute Care of Shawano at Maple Lane)
• Katie Marie Marquardt
• Tamara C Martens, LPN
• Michael Mattes

• Skilled Nursing Facility in Shawano, WI
• Providers in Shawano, WI by specialty
• Skilled Nursing Facility in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 8, 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.