Provider Demographics
NPI:1336136928
Name:ASPIRUS EXTENDED SERVICES, INC.
Entity Type:Organization
Organization Name:ASPIRUS EXTENDED SERVICES, INC.
Other - Org Name:ASPIRUS LILLIAN KERR HEALTHCARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:TREASUER
Authorized Official - Prefix:MR
Authorized Official - First Name:L.
Authorized Official - Middle Name:BRUCE
Authorized Official - Last Name:LORENZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-847-2063
Mailing Address - Street 1:2383 STATE HIGHWAY 17
Mailing Address - Street 2:
Mailing Address - City:PHELPS
Mailing Address - State:WI
Mailing Address - Zip Code:54454-9472
Mailing Address - Country:US
Mailing Address - Phone:715-545-2313
Mailing Address - Fax:715-545-3412
Practice Address - Street 1:2383 STATE HIGHWAY 17
Practice Address - Street 2:
Practice Address - City:PHELPS
Practice Address - State:WI
Practice Address - Zip Code:54454-9472
Practice Address - Country:US
Practice Address - Phone:715-545-2313
Practice Address - Fax:715-545-3412
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-29
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI314000000X
WI1124314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI20129500Medicaid
WI20129500Medicaid