Provider Demographics
NPI:1477551141
Name:BALDWIN CARE CENTER, INC.
Entity Type:Organization
Organization Name:BALDWIN CARE CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ALEXANDRA
Authorized Official - Middle Name:J
Authorized Official - Last Name:KUMMER
Authorized Official - Suffix:
Authorized Official - Credentials:LNHA
Authorized Official - Phone:715-684-3231
Mailing Address - Street 1:650 BIRCH ST
Mailing Address - Street 2:
Mailing Address - City:BALDWIN
Mailing Address - State:WI
Mailing Address - Zip Code:54002-9348
Mailing Address - Country:US
Mailing Address - Phone:715-684-3231
Mailing Address - Fax:715-684-3608
Practice Address - Street 1:650 BIRCH ST
Practice Address - Street 2:
Practice Address - City:BALDWIN
Practice Address - State:WI
Practice Address - Zip Code:54002-9348
Practice Address - Country:US
Practice Address - Phone:715-684-3231
Practice Address - Fax:715-684-3608
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-07
Last Update Date:2023-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2285314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI20146100Medicaid