Provider Demographics
NPI:1649364928
Name:WISCONSIN RAPIDS CARE CENTER LLC
Entity type:Organization
Organization Name:WISCONSIN RAPIDS CARE CENTER LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:M
Authorized Official - Last Name:PARKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-364-9754
Mailing Address - Street 1:1726 N BALLARD RD
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54911-2444
Mailing Address - Country:US
Mailing Address - Phone:920-364-9756
Mailing Address - Fax:
Practice Address - Street 1:1350 RIVER RUN DR
Practice Address - Street 2:
Practice Address - City:WISCONSIN RAPIDS
Practice Address - State:WI
Practice Address - Zip Code:54494-5487
Practice Address - Country:US
Practice Address - Phone:715-421-3140
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2015-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2100314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI20197900Medicaid
WI525212Medicare Oscar/Certification