Provider Demographics
NPI:1386637544
Name:WILLIAMS BAY CARE CENTER LLC
Entity Type:Organization
Organization Name:WILLIAMS BAY CARE CENTER LLC
Other - Org Name:ATRIUM POST ACUTE CARE OF WILLIAMS BAY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:M
Authorized Official - Last Name:PARKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-364-9754
Mailing Address - Street 1:1726 N BALLARD RD
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54911-2444
Mailing Address - Country:US
Mailing Address - Phone:920-991-9072
Mailing Address - Fax:920-749-4021
Practice Address - Street 1:146 CLOVER ST
Practice Address - Street 2:
Practice Address - City:WILLIAMS BAY
Practice Address - State:WI
Practice Address - Zip Code:53191-9779
Practice Address - Country:US
Practice Address - Phone:262-245-6400
Practice Address - Fax:262-245-9271
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-23
Last Update Date:2015-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3220314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI20188300Medicaid
WI525346Medicare Oscar/Certification