1840 Priddy Street Operating Company, LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

2807 Issued in WI

Legal business name

1840 PRIDDY STREET OPERATING COMPANY, LLC

Doing business as

Atrium Post Acute Care of Bloomer

Practice address

1840 Priddy St
Bloomer, WI 54724-1546

Phone

(715) 568-2503

Fax

(715) 568-2518

NPI assigned

Jan 14, 2016

Last updated

Apr 5, 2016By 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

Kevin P Breslin

Title

Manager

Phone

(973) 339-8892

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Atrium Post Acute Care of Bloomer Doing business as

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

{
    "created_epoch": "1452729600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1459814400000",
    "number": "1790141158",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1726 N BALLARD RD",
            "city": "APPLETON",
            "state": "WI",
            "postal_code": "549112444",
            "telephone_number": "920-991-9072",
            "fax_number": "920-749-4022"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1840 PRIDDY ST",
            "city": "BLOOMER",
            "state": "WI",
            "postal_code": "547241546",
            "telephone_number": "715-568-2503",
            "fax_number": "715-568-2518"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "1840 PRIDDY STREET OPERATING COMPANY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-01-14",
        "last_updated": "2016-04-05",
        "status": "A",
        "authorized_official_last_name": "BRESLIN",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "973-339-8892"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "WI",
            "license": "2807",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1790141158",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Atrium Post Acute Care of Bloomer",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Skilled Nursing Facility in Bloomer, WI
• Providers in Bloomer, 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 Apr 5, 2016; 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.