Healthcare Provider Details

I. General information

NPI: 1366489171
Provider Name (Legal Business Name): PARKVIEW MANOR HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2006
Last Update Date: 08/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2961 SAINT ANTHONY DR
GREEN BAY WI
54311-5860
US

IV. Provider business mailing address

2961 SAINT ANTHONY DR
GREEN BAY WI
54311-5860
US

V. Phone/Fax

Practice location:
  • Phone: 920-468-0861
  • Fax: 920-468-5897
Mailing address:
  • Phone: 920-468-0861
  • Fax: 920-468-5897

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number2680
License Number StateWI

VIII. Authorized Official

Name: KAREN S. WHITMER
Title or Position: MANAGER
Credential:
Phone: 920-468-0861