COUNTY OF SHAWANO (NPI# 1720088495) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1720088495 |
| Entity Type | Organization |
| Organization Name | COUNTY OF SHAWANO |
| Other Organization Name | MAPLE LANE HEALTH CARE CENTER |
| Practice Address |
N4231 State Highway 22 Shawano WI 54166-6130 |
| Practice Telephone | 7155263158 |
| Practice Fax Number | 7155266823 |
| Mailing Telephone | 7155263158 |
| Mailing Fax Number | 7155266823 |
| Enumeration Date | 2005-07-26 |
| Last Update Date | 2007-09-10 |
| Authorized Official Name | MRS. DEBBRA R KESSEN (ACCOUNTANT/CONTROLLER) |
| Authorized Official Telephone | 7155263158 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 315P00000X | Intermediate Care Facility, Mentally Retarded | 2994 | WI | Nursing & Custodial Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WI | 21051100 | 05 |
| Other Name | Type Code |
|---|---|
| Maple Lane Health Care Center | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174716385 | County of Shawano | Clinic/Center | 311 N Main St Rm 7, Shawano, WI 54166-2145 | 2007-08-21 |
| 1831454370 | County of Shawano | Home Health | 504 Lakeland Road, Shawano, WI 54166-3836 | 2012-07-11 |
| 1407014020 | County of Shawano | Community/Behavioral Health | 504 Lakeland Rd, Shawano, WI 54166-3836 | 2008-05-30 |
| 1336307008 | County of Shawano | Community/Behavioral Health | 504 Lakeland Rd, Shawano, WI 54166-3836 | 2008-05-29 |
| 1750549432 | County of Shawano | Community/Behavioral Health | 504 Lakeland Rd, Shawano, WI 54166-3836 | 2008-05-29 |
| 1215195987 | County of Shawano | Community/Behavioral Health | 504 Lakeland Rd, Shawano, WI 54166-3836 | 2008-05-29 |
| 1558528729 | County of Shawano | Community/Behavioral Health | 504 Lakeland Rd, Shawano, WI 54166 | 2008-05-16 |
| 1497896641 | County of Shawano | Community/Behavioral Health | 504 Lakeland Rd, Shawano, WI 54166 | 2007-02-09 |
| 1124028519 | County of Shawano | Skilled Nursing Facility | N4231 State Highway 22, Shawano, WI 54166-6130 | 2005-07-28 |
| Street Address |
N4231 STATE HIGHWAY 22 |
| City | SHAWANO |
| State | WI |
| Zip Code | 54166-6130 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1619510567 | Nsh Shawano-maple LLC | Skilled Nursing Facility | N4231 State Highway 22, Shawano, WI 54166-6130 | 2019-10-23 |
| 1922546712 | Nicholas Thiel | Physical Therapy Assistant | N4231 State Highway 22, Shawano, WI 54166-6130 | 2017-02-01 |
| 1003178807 | Mark Scott Herbert | Physical Therapist | N4231 State Highway 22, Shawano, WI 54166-6130 | 2012-06-08 |
| 1194048298 | Maple Lane Health & Rehabilitation Center LLC | Skilled Nursing Facility | N4231 State Highway 22, Shawano, WI 54166-6130 | 2010-03-04 |
| 1124028519 | County of Shawano | Skilled Nursing Facility | N4231 State Highway 22, Shawano, WI 54166-6130 | 2005-07-28 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134641848 | Nicole Jeannine Klotzbuecher | Optometrist | 150 County Road B, Shawano, WI 54166 | 2017-07-13 |
| 1437605714 | Jennifer Marie Franke | Counselor | 504 Lakeland St, Shawano, WI 54166 | 2016-08-28 |
| 1699017913 | Benjamin D Schlais | Family Medicine | 100 County Hwy B, Shawano, WI 54166 | 2013-03-25 |
| 1154574366 | Luke T Johnson | Speech-Language Pathologist | N3684 River Road, Shawano, WI 54166 | 2008-10-31 |
| 1902054315 | Robert Joseph Bohr Jr. | Physical Therapy Assistant | N6590 Fox Lane, Shawano, WI 54166 | 2008-08-28 |
| 1790945863 | Patricia Rae Ainsworth | Physical Therapist | 1436 South Lincoln Street, Shawano, WI 54166 | 2008-06-12 |
| 1649491820 | Shawano-gresham School District | Local Education Agency (LEA) | 1050 South Union Street, Shawano, WI 54166 | 2007-05-02 |
| 1114043387 | Thomas G Peterson | Optometrist | 150a County Road B, Shawano, WI 54166 | 2007-03-21 |
| 1740343086 | John Milton Dovorany | Dentist | 1488 E Green Bay St, Shawano, WI 54166 | 2006-12-18 |
| 1265526305 | Charles E Lamarche | Counselor | 420 E Green Bay St, Ste 201, Shawano, WI 54166 | 2006-10-03 |
| Find all providers in zip 54166 | ||||
| Taxonomy Code | 315P00000X |
| Grouping | Nursing & Custodial Care Facilities |
| Classification | Intermediate Care Facility, Mentally Retarded |
| (1) A public institution for care of the mentally retarded or people with related conditions. (2) An institution giving active treatment to mentally retarded or developmentally disabled persons or persons with related conditions. The primary purpose of the institution is to provide health or rehabilitative services to such individuals. |
| Notes: Sources: (1) Lexikon: Dictionary of Health Care Terms, Organizations and Acronyms for the Era of Reform, Joint Commission on Accreditation of Healthcare Organizations, Oakbrook Terrace, IL: 1994, p. 403 (2) Paraphrased from Code of Federal Regulations #42, Public Health, Section 440.150(c). |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1790036739 | United Care Homes of Wisconsin LLC | Intermediate Care Facility, Mentally Retarded | 338 Municipal Dr, West Bend, WI 53095-3510 | 2012-10-01 |
| 1114158029 | Mississippi Valley Health Services Commission | Intermediate Care Facility, Mentally Retarded | 902 Garland St E, West Salem, WI 54669-1308 | 2009-07-28 |
| 1891931085 | The Arc of Columbia County | Intermediate Care Facility, Mentally Retarded | 711 E Cook St, Portage, WI 53901-2300 | 2008-12-18 |
| 1871714543 | St. Coletta of Wisconsin | Intermediate Care Facility, Mentally Retarded | W4955 Us Highway 18, Jefferson, WI 53549-9702 | 2007-05-01 |
| 1841418415 | Mccarthy Nursing Home | Intermediate Care Facility, Mentally Retarded | 124 S Monroe St, Stoughton, WI 53589-2012 | 2007-04-20 |
| 1689890204 | Hoplite, Inc. | Intermediate Care Facility, Mentally Retarded | 1719 Washington Ave, Racine, WI 53403-2019 | 2007-04-18 |
| 1235225616 | State of Wisconsin | Intermediate Care Facility, Mentally Retarded | 2820 East Park Avenue, Chippewa Falls, WI 54729-0340 | 2006-10-05 |
| 1376531061 | Wi Il Senior Housing | Intermediate Care Facility, Mentally Retarded | 1002 Eueka Street, Ripon, WI 54971 | 2005-10-07 |
| 1265429278 | County of Grant - Orchard Manor Fdd | Intermediate Care Facility, Mentally Retarded | 8800 Hwy 61, Lancaster, WI 53813-9306 | 2005-10-04 |
| 1790771368 | Heyde Health System, Inc | Intermediate Care Facility, Mentally Retarded | 14135 150th Ave, Bloomer, WI 54724-4410 | 2005-09-20 |
| Find all providers with the same taxonomy | ||||
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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.