NPIMap

Organization Active NPI

Mellen Manor LLC

Doing business as Mellen Manor

  • Skilled Nursing Facility
  • Mellen, WI
National Provider Identifier
1669403499
Registry record updated Oct 13, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
314000000X Issued in WI
Legal business name
MELLEN MANOR LLC
Doing business as
Mellen Manor
Practice address
450 Lake Dr
Mellen, WI 54546-9750
Phone
(715) 274-5706
Fax
(715) 274-2702
NPI assigned
Jul 6, 2006
Last updated
Oct 13, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 13, 2020

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

Authorized official

Name
Jonathon Hansen, RNNPI 1982220265
Title
Ceo
Phone
(320) 828-7310

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

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

Addresses

Primary practice location

450 Lake Dr
Mellen, WI 54546-9750

Mailing address

450 Lake Dr
Mellen, WI 54546-9750
Phone (715) 274-5706

Other identifiers 2

IdentifierTypeStateIssuer
100103573MedicaidWI
20120500MedicaidWI

Other names 1

  • Mellen Manor Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1152144000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1602547200000",
    "number": "1669403499",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "450 LAKE DR",
            "city": "MELLEN",
            "state": "WI",
            "postal_code": "545469750",
            "telephone_number": "715-274-5706",
            "fax_number": "715-274-2702"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "450 LAKE DR",
            "city": "MELLEN",
            "state": "WI",
            "postal_code": "545469750",
            "telephone_number": "715-274-5706",
            "fax_number": "715-274-2702"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MELLEN MANOR LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-06",
        "last_updated": "2020-10-13",
        "certification_date": "2020-10-13",
        "status": "A",
        "authorized_official_last_name": "HANSEN",
        "authorized_official_first_name": "JONATHON",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "320-828-7310",
        "authorized_official_credential": "RN"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "WI",
            "license": "314000000X",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100103573",
            "state": "WI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "20120500",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mellen Manor",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Mellen Manor",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Mellen, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 13, 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.