Santa Maria Nursing Home, Inc.

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

1134 Issued in WI

Legal business name

SANTA MARIA NURSING HOME, INC.

Practice address

430 S Clay St
Green Bay, WI 54301-3807

Phone

(920) 432-5231

Fax

(920) 432-9881

NPI assigned

Sep 26, 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

Mrs. Helen Desotell, NHA

Title

Administrator

Phone

(920) 432-5231

Specialties & licenses 1

Addresses

Other identifiers 2

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

{
    "created_epoch": "1127692800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1578559456",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "430 S CLAY ST",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543013807",
            "telephone_number": "920-432-5231",
            "fax_number": "920-432-9881"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "430 S CLAY ST",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543013807",
            "telephone_number": "920-432-5231",
            "fax_number": "920-432-9881"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SANTA MARIA NURSING HOME, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-09-26",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "DESOTELL",
        "authorized_official_first_name": "HELEN",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "920-432-5231",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "NHA"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "WI",
            "license": "1134",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "20152400",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE NUMBER",
            "identifier": "1134",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jon Franklin Sandoval
• Heather Sanford
• Kenneth Roy Sann, LCSW, CSAC, ICS
• Yusupha Sanneh
• Keith Kenji Sano, MD
• Daniela Santiago Escamilla, MA, LPC-IT
• Bradley D Sarder, DPT
• Megan Kaye O'Brion Sarder, FNP-C
• Philip Sarge, CRNA APNP
• Tami Jay Sargent, RDH

• 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 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.