Extendicare Homes, Inc.

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

Legal business name

EXTENDICARE HOMES, INC.

Doing business as

American Heritage Care Center

Practice address

425 Davis St
Hammond, WI 54015-9615

Phone

(715) 796-2218

Fax

(715) 796-5286

NPI assigned

Nov 16, 2006

Last updated

Apr 7, 2008By 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

• American Heritage Care Center Doing business as

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

{
    "created_epoch": "1163635200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1207526400000",
    "number": "1659444883",
    "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": "425 DAVIS ST",
            "city": "HAMMOND",
            "state": "WI",
            "postal_code": "540159615",
            "telephone_number": "715-796-2218",
            "fax_number": "715-796-5286"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EXTENDICARE HOMES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-16",
        "last_updated": "2008-04-07",
        "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": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "20179200",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "American Heritage Care Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Rachel Benck, LDH
• Elizabeth Ann Brown, COTA
• CDL Psychological Services, Inc.
• Krista Demuth
• Lori Jean Edwards, RPT
• Dennis Ferguson
• FMG Davis Street SNF Wisconsin LLC (American Heritage)
• Crystal Friske, C.O.T.A.
• Amy Elizabeth Gierl, CFY-SLP
• Gilhousen Chiropractic Health & Sports Center

• Skilled Nursing Facility in Hammond, WI
• Providers in Hammond, 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 Apr 7, 2008; 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.