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NPI Code Detail

MEDICARE: CLEMENT MANOR, INC.

MEDICARE: CLEMENT MANOR, INC.
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
1314000000XSkilled Nursing Facility2724WI

Other Identifiers

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

General Provider Information

NPI Number : 1114923935
Entity Type Code : Organization
Provider Name (Legal Business Name) : CLEMENT MANOR, INC.
Provider Business Mailing Address
First Line : 3939 S 92ND ST
Second Line :
City : GREENFIELD
State : WI
Zip : 53228-2140
Country : US
Telephone Number : 414-321-1800
Fax Number : 414-546-7357
Provider Business Practice Location Address
First Line : 3939 S 92ND ST
Second Line :
City : GREENFIELD
State : WI
Zip : 53228-2140
Country : US
Telephone Number : 414-321-1800
Fax Number : 414-546-7357
Authorized Official
Title or Position : ADMINISTRATOR
Name : DENNIS FERGER
Credential :
Telephone Number : 414-546-7330
Provider Enumeration Date : 06/27/2005
Last Update Date : 08/22/2020

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