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General NPI Number Information
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NPI Number | 1902804958
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Entity Type | Organization
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Legal Business Name | OAKRIDGE GARDENS NURSING CENTER, INC.
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Dates
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Enumeration Date | 07/13/2005
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Last Update Date | 11/01/2011
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Provider Practice Location Address
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Address Line | 1700 MIDWAY RD
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City | MENASHA
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State | WI
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Zip | 54952-1230
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Country | US
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Telephone | 920-739-0111
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Fax | 920-739-4002
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Provider Business Mailing Address
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Address Line | 1700 MIDWAY RD
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City | MENASHA
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State | WI
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Zip | 54952-1230
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Country | US
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Telephone | 920-739-0111
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Fax | 920-739-4002
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. MICHAEL T SCHANKE
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Credential | N.H.A.
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Telephone | 920-739-0111
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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 | 2639
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License Number State | WI
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Legacy Identifiers
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Identifier #1
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Identifier Code | 20106700
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Identifier Type | MEDICAID
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Identifier State | WI
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Identifier Issuer |
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Proprietary Identifiers Ever Reported
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Identifier #1
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Identifier Code | 20106700
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Identifier Type | MEDICAID
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Identifier State | WI
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Identifier Issuer |
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