EXTENDICARE HOMES, INC.


Address: 1119 N Wisconsin St, Port Washington, WI 53074-1209
Phone: 2622845892

EXTENDICARE HOMES, INC. (NPI# 1407927148) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1407927148
Entity Type Organization
Organization Name EXTENDICARE HOMES, INC.
Other Organization Name HERITAGE NURSING AND REHABILITATION CENTER
Practice Address 1119 N Wisconsin St
Port Washington
WI 53074-1209
Mailing Address 111 W Michigan St
Milwaukee
WI 53203-2903
Practice Telephone 2622845892
Practice Fax Number 2622841612
Mailing Telephone 4149088119
Mailing Fax Number 4149087105
Enumeration Date 2006-11-13
Last Update Date 2008-04-07
Authorized Official Name DONNA JO MAASSEN (DIRECTOR OF COMPLIANCE)
Authorized Official Telephone 4149088119
Is Organization Subpart N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 314000000X Skilled Nursing Facility Nursing & Custodial Care Facilities

Other Provider Identifier

State Issuer Identifier Type Code
WI 20182700 05

Other Provider/Organization Names

Other Name Type Code
Heritage Nursing And Rehabilitation Center Doing Business As Name - Organization

Other Provider IDs and Locations

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
1215001862 Extendicare Homes, Inc. Skilled Nursing Facility 619 W Walnut St, Milwaukee, WI 53212-3839 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

Other Data Sources

Entity Type Entity Name Entity Address
Indiana Business Entities EXTENDICARE HOMES, INC. 3500 Lenox Road Ne, Suite 510, Atlanta, GA 30326

Office Location

Street Address 1119 N WISCONSIN ST
City PORT WASHINGTON
State WI
Zip Code 53074-1209

Providers in the same location

NPI Name Taxonomy Address Enumeration
1891213617 Nsh Port Washington LLC Skilled Nursing Facility 1119 N Wisconsin St, Port Washington, WI 53074-1209 2017-08-31
1588198857 Stephanie Cooper Speech-Language Pathologist 1119 N Wisconsin St, Port Washington, WI 53074 2017-04-13
1144698531 Brianna Rae Zimmerman Physical Therapist 1119 N Wisconsin St, Port Washington, WI 53074-1209 2015-09-02
1205228525 Fmg North Wisconsin Street Wisconsin LLC Skilled Nursing Facility 1119 N Wisconsin St, Port Washington, WI 53074-1209 2015-02-24
1235538851 Meghan Cleereman Physical Therapy Assistant 1119 N Wisconsin St, Port Washington, WI 53074-1209 2014-08-19
1295174100 Gretel Weiskopf Physical Therapy Assistant 1119 N Wisconsin St, Port Washington, WI 53074-1209 2013-06-25
1619316502 Brittney Nichole Yunto Physical Therapist 1119 N Wisconsin St, Port Washington, WI 53074-1209 2013-06-24
1730431990 Jennifer Wiedmeyer Speech-Language Pathologist 1119 N Wisconsin St, Port Washington, WI 53074-1209 2012-10-11
1457649352 Anthony Jack Ettmayer Jr. Physical Therapist 1119 N Wisconsin St, Port Washington, WI 53074-1209 2011-07-13
1417270893 Tiffany Rindt Speech-Language Pathologist 1119 N Wisconsin St, Port Washington, WI 53074-1209 2010-03-12
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Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1962045864 Heather Kay Brede Technician 857 Ashley Avenue, Port Washington, WI 53074 2019-10-23
1780062034 Amanda Zitzer Specialist/Technologist 1037 S Spring Street, Apt 257, Port Washington, WI 53074 2015-05-07
1639507643 Kelly Mulder Occupational Therapy Assistant 138 E Prospect St, Port Washington, WI 53074 2013-10-30
1235310921 Susan Ann Dobberpuhl Occupational Therapist 306 N Sprint St, Port Washington, WI 53074 2007-11-21
1245444736 Lee B Raffel Social Worker 3632 E Norport Drive, Port Washington, WI 53074 2007-05-10
1023143708 Joshua E Leute Dentist 1317 West Grand Avenue, Port Washington, WI 53074 2007-02-22
1578633806 Robert Andrew Kortsch Dentist 457 W Grand Ave, Port Washington, WI 53074 2006-11-08
1538256409 Daniel P Witkowski Dentist 1612 N Wisconsin St, Port Washington, WI 53074 2006-10-10
1477584878 Francine L Cosner Obstetrics & Gynecology 1777 W Grand Avenue, Port Washington, WI 53074 2006-07-05
1013953926 Port Washington Podiatry Inc Podiatrist 1317 W Grand Avenue, Port Washington Podiatry, Port Washington, WI 53074 2006-06-20
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Taxonomy Information

Taxonomy Code 314000000X
Grouping Nursing & Custodial Care Facilities
Classification Skilled Nursing Facility

Taxonomy Definition

(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.

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1891213617 Nsh Port Washington LLC Skilled Nursing Facility 1119 N Wisconsin St, Port Washington, WI 53074-1209 2017-08-31
1346694502 Ltc Provider Management Corp Skilled Nursing Facility 30 Wood Rd, Port Washington, NY 11050-2625 2016-04-14
1205228525 Fmg North Wisconsin Street Wisconsin LLC Skilled Nursing Facility 1119 N Wisconsin St, Port Washington, WI 53074-1209 2015-02-24
1245561075 Amsterdam House Continuing Care Retirement Community, Inc. Skilled Nursing Facility 300 E Overlook, Port Washington, NY 11050-4722 2010-01-19
1225105364 Agma Inc. Skilled Nursing Facility 1440 Port Washington Blvd, Port Washington, NY 11050-2412 2006-11-30

Providers in the same taxonomy and state

NPI Name Taxonomy Address Enumeration
1356962369 Heritage Assisted Living, LLC Skilled Nursing Facility 5020 S 107th St, Greenfield, WI 53228-3267 2020-04-30
1235762881 Imr Oak Creek Opco, LLC Skilled Nursing Facility 2700 West Honadel Boulevard, Oak Creek, WI 53154 2020-02-21
1831693936 Golden Years Nursing Home, Inc. Skilled Nursing Facility 611 Harmony Dr, Lake Geneva, WI 53147-8800 2018-03-22
1801302732 Oak Park Place of Janesville, LLC Skilled Nursing Facility 700 Myrtle Way, Janesville, WI 53545-9101 2017-12-14
1235674839 Zachary Rader Skilled Nursing Facility 645 N Church St, Elkhorn, WI 53121-2204 2017-01-05
1982155248 The Bethany-st. Joseph Corporation D/b/a Prairie Pointe Rehab Suites Skilled Nursing Facility 286 N. Willson Dr, Altoona, WI 54720 2016-10-20
1316492317 Darcy Christiansen Skilled Nursing Facility 4427 E Pic A Dilly Dr, Janesville, WI 53546-9606 2016-08-19
1366895583 Jeffrey Alan Weinshrott Skilled Nursing Facility 336 Wisconsin Ave, Sheboygan, WI 53081-4183 2016-07-22
1720433378 Kendra Meyers Skilled Nursing Facility 1806 N Hume Ave Apt 4, Marshfield, WI 54449-1677 2016-05-02
1952756991 Grace Lutheran Foundation Inc Skilled Nursing Facility 206 North Willson Drive, Altoona, WI 54720 2016-04-27
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Competitor

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City PORT WASHINGTON
Zip Code 53074

Improve Information

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Dataset Information

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.

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