MEDICARE: ELLSWORTH CARE CENTER LLC

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
1	314000000X	Skilled Nursing Facility

Other Identifiers

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

General Provider Information

NPI Number	:	1205828738
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELLSWORTH CARE CENTER LLC

Provider Business Mailing Address
First Line	:	1726 N BALLARD RD
Second Line	:
City	:	APPLETON
State	:	WI
Zip	:	54911-2444
Country	:	US
Telephone Number	:	920-991-9072
Fax Number	:	920-749-4021

Provider Business Practice Location Address
First Line	:	403 N MAPLE ST
Second Line	:
City	:	ELLSWORTH
State	:	WI
Zip	:	54011-9037
Country	:	US
Telephone Number	:	715-273-5821
Fax Number	:	715-273-5229

Authorized Official
Title or Position	:	CFO
Name	:	ROBERT M PARKINS
Credential	:
Telephone Number	:	920-364-9754

Provider Enumeration Date	:	08/19/2005
Last Update Date	:	05/27/2015

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