NPIMap

Organization Active NPI

San Luis Medical & Rehab

  • Skilled Nursing Facility
  • Green Bay, WI
National Provider Identifier
1669647673
Registry record updated Apr 30, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
SAN LUIS MEDICAL & REHAB
Practice address
2305 San Luis PL
Green Bay, WI 54304-5211
Phone
(920) 494-5231
NPI assigned
Apr 30, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 30, 2008

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

Authorized official

Name
Mrs. Andrea Marie Sheedy
Title
Cota
Phone
(920) 494-5231

Specialties & licenses 1

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

Addresses

Primary practice location

2305 San Luis PL
Green Bay, WI 54304-5211

Mailing address

2915 Shade Tree LN
Green Bay, WI 54313-7081
Phone (920) 621-3822

Other identifiers 1

IdentifierTypeStateIssuer
40867900MedicaidWI

Other names 1

  • Kindred Inc. Other name

National Provider Directory

National Provider Directory
Tax ID family
Kindred Inc11 organizations share this tax ID, including this one

Other organizations with this tax ID 10

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": "1209513600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1209513600000",
    "number": "1669647673",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2915 SHADE TREE LN",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543137081",
            "telephone_number": "920-621-3822"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2305 SAN LUIS PL",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543045211",
            "telephone_number": "920-494-5231"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SAN LUIS MEDICAL & REHAB",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-04-30",
        "last_updated": "2008-04-30",
        "status": "A",
        "authorized_official_last_name": "SHEEDY",
        "authorized_official_first_name": "ANDREA",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "COTA",
        "authorized_official_telephone_number": "920-494-5231",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "WI",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "40867900",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Kindred Inc.",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Green Bay, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 30, 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.