Evansville Manor, Inc.

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

2259 Issued in WI

Legal business name

EVANSVILLE MANOR, INC.

Practice address

470 Garfield Ave
Evansville, WI 53536-1014

Phone

(608) 882-5700

Fax

(608) 882-0833

NPI assigned

Oct 4, 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

Bonnie Martin

Title

Administrative Assistant

Phone

(608) 882-5700

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1128384000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1609863794",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "470 GARFIELD AVE",
            "city": "EVANSVILLE",
            "state": "WI",
            "postal_code": "535361014",
            "telephone_number": "608-882-5700",
            "fax_number": "608-882-0833"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "470 GARFIELD AVE",
            "city": "EVANSVILLE",
            "state": "WI",
            "postal_code": "535361014",
            "telephone_number": "608-882-5700",
            "fax_number": "608-882-0833"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVANSVILLE MANOR, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-04",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "MARTIN",
        "authorized_official_first_name": "BONNIE",
        "authorized_official_title_or_position": "ADMINISTRATIVE ASSISTANT",
        "authorized_official_telephone_number": "608-882-5700"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "WI",
            "license": "2259",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "20147800",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Core Physical Therapy, LLC
• Dean Health Systems, Inc. (SSM Health Dean Medical Group - Evansville)
• Evansville Community School District
• Evansville Eye Clinic LLC
• Evansville Manor Nursing and Rehab, LLC
• Evm Operations LLC
• Valerie Ann Farnsworth, MHA, BSN, RN-C
• Kathryn Ann Forbes
• Gerald Donald Forstrom Jr., RN, BSN
• Susan Frikken, DPT

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