NPIMap

Organization Active NPI

Extendicare Homes, Inc.

  • Skilled Nursing Facility
  • Irvine, KY
National Provider Identifier
1720150154
Registry record updated Apr 1, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
EXTENDICARE HOMES, INC.
Practice address
411 Bertha Wallace Dr
Irvine, KY 40336-9418
Phone
(606) 723-5153
Fax
(606) 723-7765
NPI assigned
Nov 14, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 1, 2008

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

Authorized official

Name
Donna Jo Maassen
Title
Director of Compliance
Phone
(414) 908-8119

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X Primary

Addresses

Primary practice location

411 Bertha Wallace Dr
Irvine, KY 40336-9418

Mailing address

111 W Michigan St
Milwaukee, WI 53203-2903
Phone (414) 908-8119

Other identifiers 1

IdentifierTypeStateIssuer
43000611MedicaidKY

Other names 1

  • Day Break Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Belair Nursing Home14 organizations share this tax ID, including this one

Other organizations with this tax ID 13

Organizations that report the same tax identification number in the National Provider Directory.

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1163462400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1207008000000",
    "number": "1720150154",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "111 W MICHIGAN ST",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532032903",
            "telephone_number": "414-908-8119",
            "fax_number": "414-908-7105"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "411 BERTHA WALLACE DR",
            "city": "IRVINE",
            "state": "KY",
            "postal_code": "403369418",
            "telephone_number": "606-723-5153",
            "fax_number": "606-723-7765"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EXTENDICARE HOMES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-14",
        "last_updated": "2008-04-01",
        "status": "A",
        "authorized_official_last_name": "MAASSEN",
        "authorized_official_first_name": "DONNA",
        "authorized_official_middle_name": "JO",
        "authorized_official_title_or_position": "DIRECTOR OF COMPLIANCE",
        "authorized_official_telephone_number": "414-908-8119"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "43000611",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Day Break",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Irvine, KY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 1, 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.