Healthcare Provider Details

I. General information

NPI: 1881690873
Provider Name (Legal Business Name): CHIPPEWA MANOR NURSING AND REHABILITATION CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2005
Last Update Date: 02/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 CHAPMAN RD
CHIPPEWA FALLS WI
54729-3253
US

IV. Provider business mailing address

222 CHAPMAN RD
CHIPPEWA FALLS WI
54729-3253
US

V. Phone/Fax

Practice location:
  • Phone: 715-723-4437
  • Fax: 715-723-0524
Mailing address:
  • Phone: 715-723-4437
  • Fax: 715-723-0524

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number2627
License Number StateWI

VIII. Authorized Official

Name: BRANDON THORSNESS
Title or Position: PRESIDENT
Credential:
Phone: 715-723-4437