Provider Demographics
NPI:1326033580
Name:COUNTY OF WAUPACA
Entity Type:Organization
Organization Name:COUNTY OF WAUPACA
Other - Org Name:LAKEVIEW MANOR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:NURSING HOME ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MEGAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:FEIRTAG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-867-2183
Mailing Address - Street 1:912 MANOR DR
Mailing Address - Street 2:
Mailing Address - City:WEYAUWEGA
Mailing Address - State:WI
Mailing Address - Zip Code:54983-8677
Mailing Address - Country:US
Mailing Address - Phone:920-867-2183
Mailing Address - Fax:920-867-2153
Practice Address - Street 1:912 MANOR DR
Practice Address - Street 2:
Practice Address - City:WEYAUWEGA
Practice Address - State:WI
Practice Address - Zip Code:54983-8677
Practice Address - Country:US
Practice Address - Phone:920-867-2183
Practice Address - Fax:920-867-2153
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-14
Last Update Date:2015-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2541314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI20161300Medicaid
WI52A297OtherFEDERAL MEDICAID
WI52A297OtherFEDERAL MEDICAID