Provider Demographics
NPI:1477598779
Name:OREGON MANOR
Entity Type:Organization
Organization Name:OREGON MANOR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:RICK
Authorized Official - Middle Name:
Authorized Official - Last Name:SCOLLON
Authorized Official - Suffix:
Authorized Official - Credentials:NHA
Authorized Official - Phone:608-835-3535
Mailing Address - Street 1:354 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:OREGON
Mailing Address - State:WI
Mailing Address - Zip Code:53575-1426
Mailing Address - Country:US
Mailing Address - Phone:608-835-3535
Mailing Address - Fax:608-835-3890
Practice Address - Street 1:354 N MAIN ST
Practice Address - Street 2:
Practice Address - City:OREGON
Practice Address - State:WI
Practice Address - Zip Code:53575-1426
Practice Address - Country:US
Practice Address - Phone:608-835-3535
Practice Address - Fax:608-835-3890
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2604314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility