St. Joseph'S Home of Our Lady of Mt Carmel Inc

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

2332 Issued in WI

Legal business name

ST. JOSEPH'S HOME OF OUR LADY OF MT CARMEL INC

Practice address

9244 29TH Ave
Kenosha, WI 53143-6602

Phone

(262) 694-0080

Fax

(262) 925-8137

NPI assigned

Oct 21, 2005

Organization subpart

No

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

Authorized official

Name

Susie K Eidsor

Title

Business Manager

Phone

(262) 925-8104

Specialties & licenses 1

Addresses

Other identifiers 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

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

{
    "created_epoch": "1129852800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1313020800000",
    "number": "1740270735",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9244 29TH AVE",
            "city": "KENOSHA",
            "state": "WI",
            "postal_code": "531436602",
            "telephone_number": "262-694-0080",
            "fax_number": "262-925-8137"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9244 29TH AVE",
            "city": "KENOSHA",
            "state": "WI",
            "postal_code": "531436602",
            "telephone_number": "262-694-0080",
            "fax_number": "262-925-8137"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST. JOSEPH'S HOME OF OUR LADY OF MT CARMEL INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-21",
        "last_updated": "2011-08-11",
        "status": "A",
        "authorized_official_last_name": "EIDSOR",
        "authorized_official_first_name": "SUSIE",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "BUSINESS MANAGER",
        "authorized_official_telephone_number": "262-925-8104"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "WI",
            "license": "2332",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "20154500",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Leilane U Sta Romana, MD
• Timothy S Staacke, M.D.
• Claire Nicole Stablein, DNP, APRN, FNP-C
• Sarah N Stachon, PAC
• Cheryl Ann Staehler, P.T.A.

• Skilled Nursing Facility in Kenosha, WI
• Providers in Kenosha, 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 11, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.