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General NPI Number Information
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NPI Number | 1700933090
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Entity Type | Organization
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Legal Business Name | THEDACARE-PEABODY MANOR
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Dates
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Enumeration Date | 01/05/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3271 FONDOTTO DR
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City | NEENAH
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State | WI
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Zip | 54956-9539
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Country | US
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Telephone | 920-225-7760
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Fax |
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Provider Business Mailing Address
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Address Line | 3271 FONDOTTO DR
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City | NEENAH
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State | WI
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Zip | 54956-9539
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | RENEE SCHUBART
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Credential | OTR
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Telephone | 920-225-7760
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 449-026
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License Number State | WI
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