Manor Care of Green Bay Wi (East) LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

2744 Issued in WI

Legal business name

MANOR CARE OF GREEN BAY WI (EAST) LLC

Practice address

600 S Webster Ave
Green Bay, WI 54301-3503

Phone

(920) 432-3213

Fax

(920) 432-0614

NPI assigned

May 25, 2006

Organization subpart

No

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

Authorized official

Name

Mr. Martin D Allen

Title

Director

Phone

(419) 252-5743

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• ManorCare Health Services-East Doing business as

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

{
    "created_epoch": "1148515200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1494460800000",
    "number": "1366498388",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "333 N SUMMIT ST",
            "city": "TOLEDO",
            "state": "OH",
            "postal_code": "436042615",
            "telephone_number": "419-252-5500",
            "fax_number": "877-385-9446"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "600 S WEBSTER AVE",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543013503",
            "telephone_number": "920-432-3213",
            "fax_number": "920-432-0614"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MANOR CARE OF GREEN BAY WI (EAST) LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-25",
        "last_updated": "2017-05-11",
        "status": "A",
        "authorized_official_last_name": "ALLEN",
        "authorized_official_first_name": "MARTIN",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "419-252-5743",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "WI",
            "license": "2744",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "20200100",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ManorCare Health Services-East",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• David Alvin Manke, MD
• Michael R Mankovecky, DPM
• Paula Manley, RN
• Randi Mann, NP
• Koti R Mannem, MD
• Manor Care of Green Bay Wi (West) LLC
• Mitchell W Manthey, MD
• Derek Manz, OT
• Ahmad A Maqboul, MD
• Ramana R Marada, MD

• Skilled Nursing Facility in Green Bay, WI
• Providers in Green Bay, 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 May 11, 2017; 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.