Extendicare Homes, Inc.

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

Legal business name

EXTENDICARE HOMES, INC.

Doing business as

Willowfield Nursing and Rehabilitation Center

Practice address

905 E Geneva St
Delavan, WI 53115-1922

Phone

(262) 728-6319

Fax

(262) 728-6693

NPI assigned

Nov 14, 2006

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

Donna Jo Maassen

Title

Director of Compliance

Phone

(414) 908-8119

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Willowfield Nursing and Rehabilitation Center Doing business as

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

{
    "created_epoch": "1163462400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1578635918",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "111 W MICHIGAN ST",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532032903",
            "telephone_number": "414-908-8119",
            "fax_number": "414-908-7105"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "905 E GENEVA ST",
            "city": "DELAVAN",
            "state": "WI",
            "postal_code": "531151922",
            "telephone_number": "262-728-6319",
            "fax_number": "262-728-6693"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EXTENDICARE HOMES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-14",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "MAASSEN",
        "authorized_official_first_name": "DONNA",
        "authorized_official_middle_name": "JO",
        "authorized_official_title_or_position": "DIRECTOR OF COMPLIANCE",
        "authorized_official_telephone_number": "414-908-8119"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "20175200",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Willowfield Nursing and Rehabilitation Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Kelly Anne Doering-Kilkenny, LPN
• Dr Howard R Henning SC
• Jean Ellen Duesterbeck, REGISTERED NURSE
• Pascalle Dumez, PT
• Mark J Eggerichs, R.PH.
• Michael J Fehling, MD
• FMG East Geneva Street Wisconsin LLC (Willowfield Nursing & Rehabilitation)
• Jessica Lynne Formea, MS, CFY-SLP
• Nicholas Matthew Franz, PHARMD
• Destry Allen Fritz, COTA

• Skilled Nursing Facility in Delavan, WI
• Providers in Delavan, 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.