Provider Demographics
NPI:1134155567
Name:DR KATE NEWCOMB CONVALESCENT CENTER,INC
Entity type:Organization
Organization Name:DR KATE NEWCOMB CONVALESCENT CENTER,INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:
Authorized Official - Last Name:MCGRATH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-356-8805
Mailing Address - Street 1:301 ELM ST
Mailing Address - Street 2:
Mailing Address - City:WOODRUFF
Mailing Address - State:WI
Mailing Address - Zip Code:54568-9149
Mailing Address - Country:US
Mailing Address - Phone:715-356-8805
Mailing Address - Fax:
Practice Address - Street 1:301 ELM ST
Practice Address - Street 2:
Practice Address - City:WOODRUFF
Practice Address - State:WI
Practice Address - Zip Code:54568-9149
Practice Address - Country:US
Practice Address - Phone:715-356-8888
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-25
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2629314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI20106200Medicaid
WI525678Medicare Oscar/Certification