The Manna House Adult Family Home

Primary specialty

Adult Day Care Clinic/CenterTaxonomy code 261QA0600X

License

0015034 Issued in WI

Legal business name

THE MANNA HOUSE ADULT FAMILY HOME

Doing business as

The Manna House

Practice address

3417 Douglas Ave
Racine, WI 53402-3751

Phone

(262) 637-8362

Fax

(262) 800-3065

NPI assigned

Apr 17, 2014

Last updated

Apr 29, 2014By 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

Mrs. Beatrice Johnson

Title

Owner

Phone

(262) 902-3338

Specialties & licenses 1

Addresses

Other names 1

• The Manna House Doing business as

Locations

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

{
    "created_epoch": "1397692800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1398729600000",
    "number": "1851711899",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2400 KINZIE AVE",
            "city": "RACINE",
            "state": "WI",
            "postal_code": "534052520",
            "telephone_number": "262-637-8362",
            "fax_number": "262-800-3065"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3417 DOUGLAS AVE",
            "city": "RACINE",
            "state": "WI",
            "postal_code": "534023751",
            "telephone_number": "262-637-8362",
            "fax_number": "262-800-3065"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE MANNA HOUSE ADULT FAMILY HOME",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-04-17",
        "last_updated": "2014-04-29",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "BEATRICE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "262-902-3338",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261QA0600X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Day Care",
            "state": "WI",
            "license": "0015034",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The Manna House",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Adult Day Care Clinic/Center in Racine, WI
• Providers in Racine, WI by specialty
• Adult Day Care Clinic/Center in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 29, 2014; 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.