NPIMap

Organization Active NPI

Theda Care Peabody Manor

  • Skilled Nursing Facility
  • Appleton, WI
National Provider Identifier
1265589303
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
9771-24 Issued in WI
Legal business name
THEDA CARE PEABODY MANOR
Practice address
2600 S Heritage Woods Dr
Appleton, WI 54915-1408
Phone
(920) 225-7764
NPI assigned
Jan 4, 2007
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Mrs. Toni Marie Radish, MSPTNPI 1710145248
Title
Physical Therapist
Phone
(920) 225-7764

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X 9771-24 WI Primary

Addresses

Primary practice location

2600 S Heritage Woods Dr
Appleton, WI 54915-1408

Mailing address

W7409 Redhawk Dr
Appleton, WI 54914-9153
Phone (920) 757-0190

National Provider Directory

National Provider Directory
Tax ID family
Novus Laboratories20 organizations share this tax ID, including this one

Other organizations with this tax ID 19

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

View all 19

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1167868800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1265589303",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "W7409 REDHAWK DR",
            "city": "APPLETON",
            "state": "WI",
            "postal_code": "549149153",
            "telephone_number": "920-757-0190"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2600 S HERITAGE WOODS DR",
            "city": "APPLETON",
            "state": "WI",
            "postal_code": "549151408",
            "telephone_number": "920-225-7764"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THEDA CARE PEABODY MANOR",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-04",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "RADISH",
        "authorized_official_first_name": "TONI",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "PHYSICAL THERAPIST",
        "authorized_official_telephone_number": "920-225-7764",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "MSPT"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "WI",
            "license": "9771-24",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Appleton, WI

Sources for this page

  • 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.