Grancare Inc

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

1044 Issued in WI

Legal business name

GRANCARE INC

Doing business as

Grancare Nursing and Rehabilitation Center

Practice address

517 E Division St
Fond Du Lac, WI 54935-3735

Phone

(920) 921-6800

Fax

(920) 921-6875

NPI assigned

Sep 27, 2005

Last updated

Aug 22, 2020By 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. William L Mackenzie

Title

Administrator

Phone

(920) 921-6800

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Grancare Nursing and Rehabilitation Center Doing business as

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

{
    "created_epoch": "1127779200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1295721991",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "517 E DIVISION ST",
            "city": "FOND DU LAC",
            "state": "WI",
            "postal_code": "549353735",
            "telephone_number": "920-921-6800",
            "fax_number": "920-921-6875"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "517 E DIVISION ST",
            "city": "FOND DU LAC",
            "state": "WI",
            "postal_code": "549353735",
            "telephone_number": "920-921-6800",
            "fax_number": "920-921-6875"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRANCARE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-09-27",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "MACKENZIE",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "920-921-6800",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "WI",
            "license": "1044",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "20193800",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Grancare Nursing and Rehabilitation Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Nancy L Goranson, PHD
• Timothy Gorges, PT
• Elizabeth A Gorman, MS CCC-A
• Michael J Grahl, M.D.
• Shaunie Elizabeth Grams, LCSW
• Eleanor R Grant
• Brenda J Grass, MD
• Robert J Grass, MD
• Mary Gravelle
• Jessica Gray, PTA

• Skilled Nursing Facility in Fond Du Lac, WI
• Providers in Fond Du Lac, 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 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.