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NPI Code Detail

MEDICARE: HEARTLAND-WASHINGTON MANOR OF KENOSHA WI LLC

MEDICARE: HEARTLAND-WASHINGTON MANOR OF KENOSHA WI LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1314000000XSkilled Nursing Facility3124WI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1609823723
Entity Type Code : Organization
Provider Name (Legal Business Name) : HEARTLAND-WASHINGTON MANOR OF KENOSHA WI LLC
Provider Business Mailing Address
First Line : 333 N SUMMIT ST
Second Line :
City : TOLEDO
State : OH
Zip : 43604-2615
Country : US
Telephone Number : 419-252-5500
Fax Number : 877-385-9446
Provider Business Practice Location Address
First Line : 3100 WASHINGTON RD
Second Line :
City : KENOSHA
State : WI
Zip : 53144-1604
Country : US
Telephone Number : 262-658-4622
Fax Number : 262-658-1503
Authorized Official
Title or Position : DIRECTOR
Name : MR. MARTIN D ALLEN
Credential :
Telephone Number : 419-252-5734
Provider Enumeration Date : 05/27/2006
Last Update Date : 05/23/2017

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Directions to “HEARTLAND-WASHINGTON MANOR OF KENOSHA WI LLC ” Practice Location

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