Provider Demographics
NPI:1689670549
Name:WOODLANDS OF GILLETT, INC.
Entity Type:Organization
Organization Name:WOODLANDS OF GILLETT, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SANDI
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHNEIDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-855-2136
Mailing Address - Street 1:430 MANOR DR
Mailing Address - Street 2:
Mailing Address - City:SURING
Mailing Address - State:WI
Mailing Address - Zip Code:54174-9182
Mailing Address - Country:US
Mailing Address - Phone:920-842-1111
Mailing Address - Fax:920-842-1153
Practice Address - Street 1:330 ROBIN HOOD LN
Practice Address - Street 2:
Practice Address - City:GILLETT
Practice Address - State:WI
Practice Address - Zip Code:54124-9201
Practice Address - Country:US
Practice Address - Phone:920-855-2136
Practice Address - Fax:920-855-1631
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-24
Last Update Date:2011-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2702314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI20188500Medicaid
WI20188500Medicaid