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Organization
MANOR CARE OF FOND DU LAC WI LLC
Active
Organization
MANOR CARE OF FOND DU LAC WI LLC
Active
Other names
ManorCare Health Services
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MARTIN D ALLEN (DIRECTOR)
(419) 252-5743
Entity
Organization
Contact information
Practice address
265 S NATIONAL AVE, FOND DU LAC, WI 54935-5334
(920) 922-7342
(920) 922-4737
Mailing address
333 N SUMMIT ST, TOLEDO, OH 43604-2615
(419) 252-5500
(877) 385-9446
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
2743
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
20199900
—
WI
Enumeration date
05/26/2006
Last updated
05/11/2017
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