Petersen Health Care of Wi, Inc.

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

2750 Issued in WI

Legal business name

PETERSEN HEALTH CARE OF WI, INC.

Practice address

903 Boyce Dr
Rhinelander, WI 54501-3836

Phone

(715) 365-6900

Fax

(715) 365-6776

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. Cindy Stanley, R.N., NHA

Title

Nursing Home Administrator

Phone

(715) 365-6863

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Taylor Park Health Care and Rehabilitation Center Doing business as

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": "1720080419",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "903 BOYCE DR",
            "address_2": "P.O. BOX 857",
            "city": "RHINELANDER",
            "state": "WI",
            "postal_code": "545013836",
            "telephone_number": "715-365-6900",
            "fax_number": "715-365-6776"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "903 BOYCE DR",
            "city": "RHINELANDER",
            "state": "WI",
            "postal_code": "545013836",
            "telephone_number": "715-365-6900",
            "fax_number": "715-365-6776"
        }
    ],
    "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": "STANLEY",
        "authorized_official_first_name": "CINDY",
        "authorized_official_title_or_position": "NURSING HOME ADMINISTRATOR",
        "authorized_official_telephone_number": "715-365-6863",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "R.N., NHA"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "WI",
            "license": "2750",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "20114700",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Taylor Park Health Care and Rehabilitation Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• 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
• Physical Therapy Center of Rhinelander, Inc.

• 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.