Provider Demographics
NPI:1114001666
Name:OREGON MANOR LTD
Entity Type:Organization
Organization Name:OREGON MANOR LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RICK
Authorized Official - Middle Name:A
Authorized Official - Last Name:SCOLLON
Authorized Official - Suffix:
Authorized Official - Credentials:NHA
Authorized Official - Phone:608-835-3535
Mailing Address - Street 1:354 N. MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:OREGON
Mailing Address - State:WI
Mailing Address - Zip Code:53575
Mailing Address - Country:US
Mailing Address - Phone:608-835-3535
Mailing Address - Fax:608-835-3890
Practice Address - Street 1:354 N. MAIN STREET
Practice Address - Street 2:
Practice Address - City:OREGON
Practice Address - State:WI
Practice Address - Zip Code:53575
Practice Address - Country:US
Practice Address - Phone:608-835-3535
Practice Address - Fax:608-835-3890
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2604314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI20100100Medicaid
WI20100100Medicaid