Provider Demographics
NPI:1376903161
Name:725 KNAPP ST OPERATING COMPANY, LLC
Entity Type:Organization
Organization Name:725 KNAPP ST OPERATING COMPANY, LLC
Other - Org Name:ATRIUM POST ACUTE CARE OF CHETEK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:P
Authorized Official - Last Name:BRESLIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-339-8892
Mailing Address - Street 1:725 KNAPP ST
Mailing Address - Street 2:
Mailing Address - City:CHETEK
Mailing Address - State:WI
Mailing Address - Zip Code:54728-9106
Mailing Address - Country:US
Mailing Address - Phone:715-924-4891
Mailing Address - Fax:715-924-4796
Practice Address - Street 1:1726 N BALLARD RD
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54911-2444
Practice Address - Country:US
Practice Address - Phone:920-991-9072
Practice Address - Fax:920-749-4022
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-07
Last Update Date:2016-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2021314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI525672Medicare Oscar/Certification
WI525672Medicare Oscar/Certification