Provider Demographics
NPI:1013904085
Name:COUNTY OF GRANT
Entity Type:Organization
Organization Name:COUNTY OF GRANT
Other - Org Name:ORCHARD MANOR NURSING HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ALESHA
Authorized Official - Middle Name:
Authorized Official - Last Name:ERDENBERGER
Authorized Official - Suffix:
Authorized Official - Credentials:NHA
Authorized Official - Phone:608-723-2113
Mailing Address - Street 1:8800 HWY 61
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:WI
Mailing Address - Zip Code:53813-9306
Mailing Address - Country:US
Mailing Address - Phone:608-723-2113
Mailing Address - Fax:608-723-2210
Practice Address - Street 1:8800 HWY 61
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:WI
Practice Address - Zip Code:53813-9306
Practice Address - Country:US
Practice Address - Phone:608-723-2113
Practice Address - Fax:608-723-2210
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-04
Last Update Date:2023-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3108314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI20153900Medicaid
WI0834840001Medicare NSC
WI20153900Medicaid