Organization
MELLEN MANOR LLC
Active
Other names
Mellen Manor
Organization subpart
No
Provider details
NPI number
Authorized official
JONATHON HANSEN RN (CEO)
(320) 828-7310
Entity
Organization
Contact information
Practice address
450 LAKE DR, MELLEN, WI 54546-9750
(715) 274-5706
(715) 274-2702
Mailing address
450 LAKE DR, MELLEN, WI 54546-9750
(715) 274-5706
(715) 274-2702
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
314000000X
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100103573
—
WI
05
—
20120500
—
WI
Enumeration date
07/06/2006
Last updated
10/13/2020
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