HCR Manor Care

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

172-019 Issued in WI

Legal business name

HCR MANOR CARE

Practice address

265 S National Ave
Fond Du Lac, WI 54935-5334

Phone

(920) 922-7342

Fax

(920) 922-7335

NPI assigned

Apr 25, 2008

Organization subpart

No

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

Authorized official

Name

Miss Angela Lee Williquette, PTA

Title

Physical Therapist Assistant

Phone

(920) 922-7324

Specialties & licenses 1

Addresses

Other identifiers 2

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

{
    "created_epoch": "1209081600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1209081600000",
    "number": "1861667248",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "265 S NATIONAL AVE",
            "city": "FOND DU LAC",
            "state": "WI",
            "postal_code": "549355334",
            "telephone_number": "920-922-7342",
            "fax_number": "920-922-7335"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "265 S NATIONAL AVE",
            "city": "FOND DU LAC",
            "state": "WI",
            "postal_code": "549355334",
            "telephone_number": "920-922-7342",
            "fax_number": "920-922-7335"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HCR MANOR CARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-04-25",
        "last_updated": "2008-04-25",
        "status": "A",
        "authorized_official_last_name": "WILLIQUETTE",
        "authorized_official_first_name": "ANGELA",
        "authorized_official_middle_name": "LEE",
        "authorized_official_title_or_position": "PHYSICAL THERAPIST ASSISTANT",
        "authorized_official_telephone_number": "920-922-7324",
        "authorized_official_name_prefix": "Miss",
        "authorized_official_credential": "PTA"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "WI",
            "license": "172-019",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WISCONSIN STATE LICENSE",
            "identifier": "172-019",
            "state": "WI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "40320900",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Yasir Hatahet, MD
• David T Haubenschild, MD
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• Ryan David Haus, DC
• Darrell E Hay, MD
• Kathleen Heaney
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• Sean P Hedican, MD
• Emma Irean Heenan, RN
• Alexandria Lynn Hefter, APNP

• Skilled Nursing Facility in Fond Du Lac, WI
• Providers in Fond Du Lac, 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 25, 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.