NPIMap

Organization Active NPI

Sheboygan Senior Community

  • Skilled Nursing Facility
  • Reedsville, WI
National Provider Identifier
1609219195
Registry record updated Apr 15, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
4640-27 Issued in WI
Legal business name
SHEBOYGAN SENIOR COMMUNITY
Practice address
5314 Grove Rd
Reedsville, WI 54230-9131
Phone
(920) 228-0464
Fax
(920) 459-0638
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
Joan Kleist
Title
DO
Phone
(920) 458-2137

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X 4640-27 WI Primary

Addresses

Primary practice location

5314 Grove Rd
Reedsville, WI 54230-9131

Mailing address

5314 Grove Rd
Reedsville, WI 54230-9131
Phone (920) 228-0464

Other identifiers 1

IdentifierTypeStateIssuer
526538MedicaidWI

Other names 1

  • Rehabcare/Kindred 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.

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": "1609219195",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5314 GROVE RD",
            "city": "REEDSVILLE",
            "state": "WI",
            "postal_code": "542309131",
            "telephone_number": "920-228-0464",
            "fax_number": "920-459-0638"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5314 GROVE RD",
            "city": "REEDSVILLE",
            "state": "WI",
            "postal_code": "542309131",
            "telephone_number": "920-228-0464",
            "fax_number": "920-459-0638"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHEBOYGAN SENIOR COMMUNITY",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-04-15",
        "last_updated": "2013-04-15",
        "status": "A",
        "authorized_official_last_name": "KLEIST",
        "authorized_official_first_name": "JOAN",
        "authorized_official_title_or_position": "DO",
        "authorized_official_telephone_number": "920-458-2137"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "WI",
            "license": "4640-27",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "526538",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Rehabcare/Kindred",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Reedsville, 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.