Organization Active NPI

Woodland Village, Inc.

  • Skilled Nursing Facility
  • Suring, WI
National Provider Identifier
1336145291
Registry record updated Nov 4, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
2698 Issued in WI
Legal business name
WOODLAND VILLAGE, INC.
Practice address
430 Manor Dr
Suring, WI 54174-9182
Phone
(920) 842-2191
Fax
(920) 842-2176
NPI assigned
Jun 24, 2005
Last updated
Nov 4, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 4, 2011

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

Authorized official

Name
Mr. Ron Christensen
Title
Administrator
Phone
(920) 842-2191

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X 2698 WI Primary

Addresses

Primary practice location

430 Manor Dr
Suring, WI 54174-9182

Mailing address

430 Manor Dr
Suring, WI 54174-9182
Phone (920) 842-2191

Other identifiers 1

IdentifierTypeStateIssuer
20111200MedicaidWI

National Provider Directory

National Provider Directory

Locations

410 N US Highway 141
Crivitz, WI 54114
Phone 5166059800 ext. 1004

425 Manor Dr
Suring, WI 54174
Phone (516) 605-9800

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": "1119571200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1320364800000",
    "number": "1336145291",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "430 MANOR DR",
            "city": "SURING",
            "state": "WI",
            "postal_code": "541749182",
            "telephone_number": "920-842-2191",
            "fax_number": "920-842-2176"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "430 MANOR DR",
            "city": "SURING",
            "state": "WI",
            "postal_code": "541749182",
            "telephone_number": "920-842-2191",
            "fax_number": "920-842-2176"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WOODLAND VILLAGE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-06-24",
        "last_updated": "2011-11-04",
        "status": "A",
        "authorized_official_last_name": "CHRISTENSEN",
        "authorized_official_first_name": "RON",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "920-842-2191",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "WI",
            "license": "2698",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "20111200",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Suring, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 4, 2011; 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.