Petersen Health Care of Wi, Inc.

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

2751 Issued in WI

Legal business name

PETERSEN HEALTH CARE OF WI, INC.

Practice address

900 Boyce Dr
Rhinelander, WI 54501-3835

Phone

(715) 365-6900

Fax

(715) 365-6665

NPI assigned

Aug 11, 2005

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Andrea Allard, NHA

Title

Nursing Home Administrator

Phone

(715) 365-6449

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Friendly Village Doing business as

Tax ID family

Friendly Village2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Petersen Health Care of Wi, Inc.

  • Intellectual and/or Developmental Disabilities Residential Treatment Facility
  • Rhinelander, WI
  • NPI 1093700098
  NPD tax ID

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

{
    "created_epoch": "1123718400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1659373348",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "900 BOYCE DR",
            "address_2": "P.O. BOX 857",
            "city": "RHINELANDER",
            "state": "WI",
            "postal_code": "545013835",
            "telephone_number": "715-365-6900",
            "fax_number": "715-365-6665"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "900 BOYCE DR",
            "city": "RHINELANDER",
            "state": "WI",
            "postal_code": "545013835",
            "telephone_number": "715-365-6900",
            "fax_number": "715-365-6665"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PETERSEN HEALTH CARE OF WI, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-08-11",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "ALLARD",
        "authorized_official_first_name": "ANDREA",
        "authorized_official_title_or_position": "NURSING HOME ADMINISTRATOR",
        "authorized_official_telephone_number": "715-365-6449",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "NHA"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "WI",
            "license": "2751",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "20114800",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Friendly Village",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Danielle Perner, DPT
• James P Perra
• Tammery M Perry, APNP
• Petco Wellness LLC
• Petersen Health Care of Wi, Inc.
• Petersen Health Care of Wi, Inc.
• Petersen Rehabilitation Center, Inc.
• Nicole Marie Peterson, FNP-C
• Shawn Ann Pflugardt, PSY.D.
• Physical Medicine of Northern Wisconsin SC

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