Organization
MANAWA COMMUNITY NURSING CENTER INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RUSSELL JOSEPH MATICEK SR. (OWNER)
(920) 596-2566
Entity
Organization
Contact information
Practice address
400 E 4TH ST, MANAWA, WI 54949
(920) 596-2566
(920) 596-2588
Mailing address
400 E 4TH ST, MANAWA, WI 54949-9227
(920) 596-2566
(920) 596-2588
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
2616
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
20105000
—
WI
Enumeration date
05/27/2005
Last updated
12/14/2009
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