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NPI Code Detail

MEDICARE: SHEBOYGAN SENIOR COMMUNITY, INC.

MEDICARE: SHEBOYGAN SENIOR COMMUNITY, INC.
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 Facility2662WI

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 : 1831197425
Entity Type Code : Organization
Provider Name (Legal Business Name) : SHEBOYGAN SENIOR COMMUNITY, INC.
Provider Business Mailing Address
First Line : 3505 CTY RD. Y
Second Line :
City : SHEBOYGAN
State : WI
Zip : 53083-2400
Country : US
Telephone Number : 920-458-2137
Fax Number : 920-458-5922
Provider Business Practice Location Address
First Line : 3505 CTY RD. Y
Second Line :
City : SHEBOYGAN
State : WI
Zip : 53083-2400
Country : US
Telephone Number : 920-458-2137
Fax Number : 920-458-5922
Authorized Official
Title or Position : ADMINISTRATOR
Name : JOAN KLEIST
Credential : RN, HNA
Telephone Number : 920-458-2137
Provider Enumeration Date : 07/08/2005
Last Update Date : 11/23/2015

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Directions to “SHEBOYGAN SENIOR COMMUNITY, INC. ” Practice Location

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