Active NPI
Willowbrook Nursing & Rehab Center
- Skilled Nursing Facility
- Lake Mills, WI
National Provider Identifier
1376773499
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Skilled Nursing Facility
- License
- 11296024
- Legal business name
- WILLOWBROOK NURSING & REHAB CENTER
- Practice address
- 901 Mulberry St
Lake Mills, WI 53551-1335 - Phone
- (920) 648-3144
- Fax
- (920) 648-3441
- NPI assigned
- Jul 23, 2009
- Organization subpart
- Yes
- Parent organization
- EXTENDICARE
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Ann Evenson, SLP
- Title
- FRC
- Phone
- (920) 648-3144
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Skilled Nursing Facility | 314000000X | 11296024 | WI | Primary |
Addresses
Primary practice location
901 Mulberry St
Lake Mills, WI 53551-1335
Mailing address
901 Mulberry St
Lake Mills, WI 53551-1335
National Provider Directory
National Provider Directory- Part of
- Mayville Nursing and Rehab
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1248307200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1248307200000",
"number": "1376773499",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "901 MULBERRY ST",
"city": "LAKE MILLS",
"state": "WI",
"postal_code": "535511335"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "901 MULBERRY ST",
"city": "LAKE MILLS",
"state": "WI",
"postal_code": "535511335",
"telephone_number": "920-648-3144",
"fax_number": "920-648-3441"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "WILLOWBROOK NURSING & REHAB CENTER",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "EXTENDICARE",
"enumeration_date": "2009-07-23",
"last_updated": "2009-07-23",
"status": "A",
"authorized_official_last_name": "EVENSON",
"authorized_official_first_name": "ANN",
"authorized_official_title_or_position": "FRC",
"authorized_official_telephone_number": "920-648-3144",
"authorized_official_credential": "SLP"
},
"taxonomies": [
{
"code": "314000000X",
"taxonomy_group": "",
"desc": "Skilled Nursing Facility",
"state": "WI",
"license": "11296024",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lake Mills, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 23, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.