Organization
MANOR CARE OF SHAWANO WI LLC
Active
Other names
ManorCare Health Services - Shawano
Organization subpart
No
Provider details
NPI number
Authorized official
MR. BARRY A. LAZARUS (VICE PRESIDENT-REIMBURSEMENT)
(419) 252-5541
Entity
Organization
Contact information
Practice address
1436 S LINCOLN ST, SHAWANO, WI 54166-3427
(715) 526-6111
(715) 524-5708
Mailing address
333 N SUMMIT ST, 4TH FLOOR ATTN BARRY LAZARUS, TOLEDO, OH 43604-1531
(419) 252-5541
(419) 252-5548
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
3175
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
20200500
—
WI
Enumeration date
05/27/2006
Last updated
02/08/2008
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