Kenneth J & Marilyn M Secor

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

410310 Issued in WI

Legal business name

KENNETH J & MARILYN M SECOR

Doing business as

Silver Leaf Manor

Practice address

1310 Lincoln St
Kewaunee, WI 54216-1606

Phone

(920) 388-2204

Fax

(920) 388-2202

NPI assigned

Aug 5, 2007

Organization subpart

No

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

Authorized official

Name

Mr. Kenneth J Secor

Title

Owner

Phone

(920) 388-2204

Specialties & licenses 1

Addresses

Other names 1

• Silver Leaf Manor Doing business as

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

CLIA laboratory certificates

Tax ID family

Kenneth J Marilyn M Secor2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

• Kenneth J & Marilyn M Secor

  • Assisted Living Facility
  • Kewaunee, WI
  • NPI 1578754511
  NPD tax ID

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

{
    "created_epoch": "1186272000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1186272000000",
    "number": "1952592065",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1310 LINCOLN ST",
            "city": "KEWAUNEE",
            "state": "WI",
            "postal_code": "542161606",
            "telephone_number": "920-388-2204",
            "fax_number": "920-388-2202"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1310 LINCOLN ST",
            "city": "KEWAUNEE",
            "state": "WI",
            "postal_code": "542161606",
            "telephone_number": "920-388-2204",
            "fax_number": "920-388-2202"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KENNETH J & MARILYN M SECOR",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-08-05",
        "last_updated": "2007-08-05",
        "status": "A",
        "authorized_official_last_name": "SECOR",
        "authorized_official_first_name": "KENNETH",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "920-388-2204",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "WI",
            "license": "410310",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Silver Leaf Manor",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Lindsey Jane Jenerjohn
• Jeffrey H Jenswold, MSW CICSW CADC
• Rebecca M Kasten, LMT
• Tricia Lynn Keister, R.N.
• Kenneth J & Marilyn M Secor
• Kewaunee Care Center LLC
• Kewaunee Chiropractic Works LLC
• Kewaunee Hometown Pharmacy LLC
• Kewaunee School District
• Kelly J Kovnesky, LPC-IT

• Assisted Living Facility in Kewaunee, WI
• Providers in Kewaunee, WI by specialty
• Assisted Living Facility in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 5, 2007; 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.