Provider Demographics
NPI:1407849664
Name:SINSINAWA NURSING INC
Entity Type:Organization
Organization Name:SINSINAWA NURSING INC
Other - Org Name:SAINT DOMINIC VILLA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MS
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:CHWALA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-206-4983
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 1:2375 SINSINAWA RD
Practice Address - Street 2:
Practice Address - City:HAZEL GREEN
Practice Address - State:WI
Practice Address - Zip Code:53811-9707
Practice Address - Country:US
Practice Address - Phone:608-748-9814
Practice Address - Fax:608-748-9945
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-23
Last Update Date:2022-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5006314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI20187600Medicaid
WI20187600Medicaid