EXTENDICARE HOMES, INC. (NPI# 1215001862) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1215001862 |
| Entity Type | Organization |
| Organization Name | EXTENDICARE HOMES, INC. |
| Other Organization Name | PLYMOUTH MANOR NURSING & REHABILITATION CENTER |
| Practice Address |
619 W Walnut St Milwaukee WI 53212-3839 |
| Mailing Address |
111 W Michigan St Milwaukee WI 53203-2903 |
| Practice Telephone | 4142631770 |
| Practice Fax Number | 4142632467 |
| Mailing Telephone | 4149088119 |
| Mailing Fax Number | 4149087105 |
| Enumeration Date | 2006-11-17 |
| Last Update Date | 2008-04-07 |
| Authorized Official Name | DONNA JO MAASSEN (DIRECTOR OF COMPLIANCE) |
| Authorized Official Telephone | 4149088119 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 314000000X | Skilled Nursing Facility | Nursing & Custodial Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WI | 20115800 | 05 |
| Other Name | Type Code |
|---|---|
| Plymouth Manor Nursing & Rehabilitation Center | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1740345800 | Extendicare Homes, Inc. | Assisted Living Facility | 100 E Dalke Ave, Spokane, WA 99208-1006 | 2006-12-27 |
| 1639245558 | Extendicare Homes, Inc. | Skilled Nursing Facility | 1902 Mead Ave, Sheboygan, WI 53081-6140 | 2006-11-24 |
| 1912070624 | Extendicare Homes, Inc. | Skilled Nursing Facility | 414 Robey St, Franklin, KY 42134-1034 | 2006-11-17 |
| 1043383771 | Extendicare Homes, Inc. | Skilled Nursing Facility | 2500 N Elm St, Henderson, KY 42420-2005 | 2006-11-17 |
| 1790859486 | Extendicare Homes, Inc. | Skilled Nursing Facility | 3431 N 13th St, Sheboygan, WI 53083-2938 | 2006-11-17 |
| 1871666560 | Extendicare Homes, Inc. | Skilled Nursing Facility | 1561 Newton Ave, Bowling Green, KY 42104-3238 | 2006-11-17 |
| 1619041340 | Extendicare Homes, Inc. | Skilled Nursing Facility | 867 Mcguire Ave, Paducah, KY 42001-4036 | 2006-11-17 |
| 1255405700 | Extendicare Homes, Inc. | Skilled Nursing Facility | 2582 Cerulean Rd, Cadiz, KY 42211-9605 | 2006-11-17 |
| 1376617837 | Extendicare Homes, Inc. | Skilled Nursing Facility | 420 E Grundy Ave, Springfield, KY 40069-1173 | 2006-11-17 |
| 1184798712 | Extendicare Homes, Inc. | Skilled Nursing Facility | 4415 W 36 1/2 St, St Louis Park, MN 55416-4854 | 2006-11-17 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Indiana Business Entities | EXTENDICARE HOMES, INC. | 3500 Lenox Road Ne, Suite 510, Atlanta, GA 30326 |
| Street Address |
619 W WALNUT ST |
| City | MILWAUKEE |
| State | WI |
| Zip Code | 53212-3839 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679077481 | Lauren Rae Frank | Nurse Practitioner | 619 W Walnut St, Milwaukee, WI 53212-3839 | 2018-03-19 |
| 1942752506 | Heather L. Marschall | Nurse Practitioner | 619 W Walnut St, Milwaukee, WI 53212-3839 | 2016-10-31 |
| 1164897435 | Kelee Dangles | Counselor | 619 W Walnut St, Milwaukee, WI 53212-3839 | 2015-12-11 |
| 1669872818 | Jessica Scheunemann | Counselor | 619 W Walnut St, Milwaukee, WI 53212-3839 | 2014-08-25 |
| 1831437581 | Children's Hospital of Wisconsin | Pediatrics | 619 W Walnut St, Milwaukee, WI 53212-3839 | 2013-01-30 |
| 1609182161 | Tia C Medley | Nurse Practitioner | 619 W Walnut St, Ms 958, Milwaukee, WI 53212-3839 | 2010-08-23 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609481001 | Beth Leanna | Counselor | Benedict Center 1849 N Dr. Marin Luther King Dr., Suite 101, Milwaukee, WI 53212 | 2020-09-11 |
| 1326683749 | A.b.d.h. Counseling Services LLC | Clinic/Center | 518 E Concordia Avenue, Milwaukee, WI 53212 | 2019-11-08 |
| 1467095703 | Ifrah Hameed | Psychologist | 1849 N Doctor M.l.k. Jr Dr# 101, Milwaukee, WI 53212 | 2019-10-18 |
| 1386293330 | Rachel Mae Nelson Bagha | Student in an Organized Health Care Education/Training Program | 1849 N Doctor M.l.k. Jr Dr #101, Milwaukee, WI 53212 | 2019-09-11 |
| 1164085205 | Mary Sue Daase Bowen | Counselor | 2821 N 4th Street, Milwaukee, WI 53212 | 2019-04-15 |
| 1649733189 | Stacey King | Counselor | Rivershore Comprehensive Treatment Facility, 3703 N Richards St, Milwaukee Wi, Milwaukee, WI 53212 | 2019-04-11 |
| 1710447701 | Scott William Stauder | Student in an Organized Health Care Education/Training Program | 1121 E. North Ave., Milwaukee, WI 53212 | 2019-03-25 |
| 1821561168 | Lydia Ann Mendez | Counselor | 3703 N Richards St, Milwaukee, WI 53212 | 2019-01-09 |
| 1851863302 | Glen Victor Fleming | Counselor | 2821 North 4th Street Suite 210, Milwaukee, WI 53212 | 2018-12-21 |
| 1093285140 | Megan Marie Volp | Advanced Practice Midwife | 2555 N Doctor M.l.k. Jr Dr, Milwaukee, WI 53212 | 2018-12-03 |
| Find all providers in zip 53212 | ||||
| Taxonomy Code | 314000000X |
| Grouping | Nursing & Custodial Care Facilities |
| Classification | Skilled Nursing Facility |
| (1) A skilled nursing facility is a facility or distinct part of an institution whose primary function is to provide medical, continuous nursing, and other health and social services to patients who are not in an acute phase of illness requiring services in a hospital, but who require primary restorative or skilled nursing services on an inpatient basis above the level of intermediate or custodial care in order to reach a degree of body functioning to permit self care in essential daily living. It meets any licensing or certification standards et forth by the jurisdiction where it is located. A skilled nursing facility may be a freestanding facility or part of a hospital that has been certified by Medicare to admit patients requiring subacute care and rehabilitation; (2) Provides non-acute medical and skilled nursing care services, therapy and social services under the supervision of a licensed registered nurse on a 24-hour basis. |
| Notes: Source: (1) "Glossary of terms used in managed care" Developed by the Managed Care Assembly (MCA) of Medical Group Management Association (MGMA), MGM Journal, September/October 1995, p. 64; (2) AHA Guide, 1996 Annual Survey. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1780079046 | Rivershore Clinic | Skilled Nursing Facility | 3707 N. Richards St., Milwaukee Health Service, Milwaukee, WI 53212-1673 | 2015-04-03 |
| 1184943540 | Heavenly Touch Nursing | Skilled Nursing Facility | 5606 N 94th St, Milwaukee, WI 53225-2602 | 2010-05-25 |
| 1962731331 | Highland Heights | Skilled Nursing Facility | 2816 N 49th St, Milwaukee, WI 53210-1651 | 2009-12-15 |
| 1427385038 | Marys Adult Family Services LLC | Skilled Nursing Facility | 2802 N 40th St, Suite 210, Milwaukee, WI 53210-1806 | 2009-11-03 |
| 1649464645 | Independent Nurse | Skilled Nursing Facility | 1919 N 19th St, Milwaukee, WI 53205-1547 | 2007-09-02 |
| 1740482181 | Diane L Weidner | Skilled Nursing Facility | 190 W Allerton Ave, Milwaukee, WI 53207-4910 | 2007-06-05 |
| 1235355967 | Dominican Sisters Corp. St Ann Rest Home | Skilled Nursing Facility | 2020 S Muskego Ave, Milwaukee, WI 53204-3622 | 2007-04-18 |
| 1295866325 | Saint John's Communities, Inc. | Skilled Nursing Facility | 1840 N Prospect Ave, Milwaukee, WI 53202-1975 | 2007-03-08 |
| 1578612081 | Cameo Care Center Inc. | Skilled Nursing Facility | 5790 S 27th St, Milwaukee, WI 53221-4129 | 2007-01-10 |
| 1215092184 | Delphi Healthcare LLC | Skilled Nursing Facility | 2115 E Woodstock Pl, Milwaukee, WI 53202-1342 | 2006-12-22 |
| Find all providers in MILWAUKEE | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.