Provider Demographics
NPI:1154320802
Name:BARRON HEALTHCARE CENTER INC.
Entity Type:Organization
Organization Name:BARRON HEALTHCARE CENTER INC.
Other - Org Name:BARRON RIVERSIDE MANOR
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GRANT
Authorized Official - Middle Name:D
Authorized Official - Last Name:THAYER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-837-1222
Mailing Address - Street 1:660 E BIRCH AVE
Mailing Address - Street 2:
Mailing Address - City:BARRON
Mailing Address - State:WI
Mailing Address - Zip Code:54812-9130
Mailing Address - Country:US
Mailing Address - Phone:715-537-5643
Mailing Address - Fax:
Practice Address - Street 1:660 E BIRCH AVE
Practice Address - Street 2:
Practice Address - City:BARRON
Practice Address - State:WI
Practice Address - Zip Code:54812-9130
Practice Address - Country:US
Practice Address - Phone:715-537-5643
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-15
Last Update Date:2007-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3038314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI20167400Medicaid
WI525648AAMedicare ID - Type UnspecifiedMEDICARE