MEDICARE: PARK MANOR, LTD.

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
1	314000000X	Skilled Nursing Facility	3674-026	WI

Other Identifiers

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

General Provider Information

NPI Number	:	1871583443
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PARK MANOR, LTD.

Provider Business Mailing Address
First Line	:	124 W 3RD ST
Second Line	:	P.O. BOX 727
City	:	WASHBURN
State	:	WI
Zip	:	54891-9507
Country	:	US
Telephone Number	:	715-492-6168
Fax Number	:

Provider Business Practice Location Address
First Line	:	250 LAWRENCE AVE
Second Line	:
City	:	PARK FALLS
State	:	WI
Zip	:	54552-1431
Country	:	US
Telephone Number	:	715-762-2449
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE ADMINISTRATOR
Name	:	SHARON SCHULTZ
Credential	:
Telephone Number	:	715-762-2449

Provider Enumeration Date	:	10/25/2005
Last Update Date	:	08/22/2020

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Directions to “PARK MANOR, LTD. ” Practice Location

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