NPIMap

Organization Active NPI

Sheboygan Senior Com

  • Skilled Nursing Facility
  • Random Lake, WI
National Provider Identifier
1356784888
Registry record updated Apr 15, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
1862-19 Issued in WI
Legal business name
SHEBOYGAN SENIOR COM
Practice address
307 Lake Dr
Random Lake, WI 53075-1764
Phone
(920) 447-3041
NPI assigned
Apr 15, 2013
Last updated
Apr 15, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 15, 2013

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

Authorized official

Name
Mrs. Sheryl Ann Knorr I, PTANPI 1427426246
Title
Physical Therapy Assistant
Phone
(920) 459-0637

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X 1862-19 WI Primary

Addresses

Primary practice location

307 Lake Dr
Random Lake, WI 53075-1764

Mailing address

307 Lake Dr
Random Lake, WI 53075-1764
Phone (920) 447-3041

Other names 1

  • Rehab/KindredCare Other name

National Provider Directory

National Provider Directory
Tax ID family
Kindred3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

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": "1365984000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1365984000000",
    "number": "1356784888",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "307 LAKE DR",
            "city": "RANDOM LAKE",
            "state": "WI",
            "postal_code": "530751764",
            "telephone_number": "920-447-3041"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "307 LAKE DR",
            "city": "RANDOM LAKE",
            "state": "WI",
            "postal_code": "530751764",
            "telephone_number": "920-447-3041"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHEBOYGAN SENIOR COM",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-04-15",
        "last_updated": "2013-04-15",
        "status": "A",
        "authorized_official_last_name": "KNORR",
        "authorized_official_first_name": "SHERYL",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "PHYSICAL  THERAPY ASSISTANT",
        "authorized_official_telephone_number": "920-459-0637",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_name_suffix": "I",
        "authorized_official_credential": "PTA"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "WI",
            "license": "1862-19",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Rehab/KindredCare",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Random Lake, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 15, 2013; 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.