NPIMap

Organization Active NPI

County of Shawano

Doing business as Maple Lane Health Care Center

  • Intellectual Disabilities Intermediate Care Facility
  • Shawano, WI
National Provider Identifier
1720088495
Registry record updated Sep 10, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual Disabilities Intermediate Care FacilityTaxonomy code 315P00000X
License
2994 Issued in WI
Legal business name
COUNTY OF SHAWANO
Doing business as
Maple Lane Health Care Center
Practice address
N4231 State Highway 22
Shawano, WI 54166-6130
Phone
(715) 526-3158
Fax
(715) 526-6823
NPI assigned
Jul 26, 2005
Last updated
Sep 10, 2007By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 10, 2007

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

Authorized official

Name
Mrs. Debbra R Kessen
Title
Accountant/Controller
Phone
(715) 526-3158

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual Disabilities Intermediate Care Facility 315P00000X 2994 WI Primary

Addresses

Primary practice location

N4231 State Highway 22
Shawano, WI 54166-6130

Mailing address

N4231 State Highway 22
Shawano, WI 54166-6130
Phone (715) 526-3158

Other identifiers 1

IdentifierTypeStateIssuer
21051100MedicaidWI

Other names 1

  • Maple Lane Health Care Center Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Shawano County Department of Community Program11 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": "1122336000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1189382400000",
    "number": "1720088495",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "N4231 STATE HIGHWAY 22",
            "city": "SHAWANO",
            "state": "WI",
            "postal_code": "541666130",
            "telephone_number": "715-526-3158",
            "fax_number": "715-526-6823"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "N4231 STATE HIGHWAY 22",
            "city": "SHAWANO",
            "state": "WI",
            "postal_code": "541666130",
            "telephone_number": "715-526-3158",
            "fax_number": "715-526-6823"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COUNTY OF SHAWANO",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-07-26",
        "last_updated": "2007-09-10",
        "status": "A",
        "authorized_official_last_name": "KESSEN",
        "authorized_official_first_name": "DEBBRA",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "ACCOUNTANT/CONTROLLER",
        "authorized_official_telephone_number": "715-526-3158",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": "WI",
            "license": "2994",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "21051100",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Maple Lane Health Care Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Shawano, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 10, 2007; 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.