MEDICARE: WOODLANDS OF GILLETT, 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
1	314000000X	Skilled Nursing Facility	2702	WI

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	:	1689670549
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WOODLANDS OF GILLETT, INC.

Provider Business Mailing Address
First Line	:	430 MANOR DR
Second Line	:
City	:	SURING
State	:	WI
Zip	:	54174-9182
Country	:	US
Telephone Number	:	920-842-1111
Fax Number	:	920-842-1153

Provider Business Practice Location Address
First Line	:	330 ROBIN HOOD LN
Second Line	:
City	:	GILLETT
State	:	WI
Zip	:	54124-9201
Country	:	US
Telephone Number	:	920-855-2136
Fax Number	:	920-855-1631

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MS. SANDI SCHNEIDER
Credential	:
Telephone Number	:	920-855-2136

Provider Enumeration Date	:	06/24/2005
Last Update Date	:	11/04/2011

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