Basic Information
| Provider Information | |||||||||
| NPI: | 1013386614 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SHAWANO HEALTH SERVICES LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5536 N KENT AVE | ||||||||
| Address2: | |||||||||
| City: | WHITEFISH BAY | ||||||||
| State: | WI | ||||||||
| PostalCode: | 532175155 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6366988600 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1436 S LINCOLN ST | ||||||||
| Address2: | |||||||||
| City: | SHAWANO | ||||||||
| State: | WI | ||||||||
| PostalCode: | 541663427 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7155266111 | ||||||||
| FaxNumber: | 7155245708 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/24/2015 | ||||||||
| LastUpdateDate: | 09/24/2015 | ||||||||
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| AuthorizedOfficialLastName: | HOEHN | ||||||||
| AuthorizedOfficialFirstName: | JEFFREY | ||||||||
| AuthorizedOfficialMiddleName: | CHARLES | ||||||||
| AuthorizedOfficialTitleorPosition: | MEMBER MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 6366988600 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | 3175 | WI | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
No ID Information.