Edenbrook on Oneida Nursing and Rehab LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

Legal business name

EDENBROOK ON ONEIDA NURSING AND REHAB LLC

Doing business as

Edenbrook Appleton South

Practice address

1335 S Oneida St
Appleton, WI 54915-1351

Phone

(920) 731-6646

NPI assigned

Jan 21, 2020

Last updated

Jan 21, 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

Anya Vistman

Title

Corporate Counsel

Phone

(773) 825-3336

Specialties & licenses 1

Addresses

Other names 1

• EDENBROOK APPLETON SOUTH Doing business as

Locations

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

{
    "created_epoch": "1579564800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1579564800000",
    "number": "1710517529",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8170 MCCORMICK BLVD STE 112",
            "city": "SKOKIE",
            "state": "IL",
            "postal_code": "600762914",
            "telephone_number": "773-825-3336"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1335 S ONEIDA ST",
            "city": "APPLETON",
            "state": "WI",
            "postal_code": "549151351",
            "telephone_number": "920-731-6646"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EDENBROOK ON ONEIDA NURSING AND REHAB LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-01-21",
        "last_updated": "2020-01-21",
        "certification_date": "2020-01-21",
        "status": "A",
        "authorized_official_last_name": "VISTMAN",
        "authorized_official_first_name": "ANYA",
        "authorized_official_title_or_position": "CORPORATE COUNSEL",
        "authorized_official_telephone_number": "773-825-3336"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "EDENBROOK APPLETON SOUTH",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Peggy A Ebben, LPN
• Stacie A Ebben, NP
• Tammy Lynn Ebben
• Kristen R Ebert, FNP-C
• Edenbrook on Meade Nursing and Rehab LLC (Edenbrook of Appleton-North)
• Alissa Edwards, D.D.S.
• Michelle A Edwards, MD
• Kyra Egan
• David Allen Eggert, MD
• Madeline Shane Eggert, PA-C

• Skilled Nursing Facility in Appleton, WI
• Providers in Appleton, 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 Jan 21, 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.