Provider Demographics
NPI:1841283934
Name:ASPIRUS EXTENDED SERVICES, INC.
Entity type:Organization
Organization Name:ASPIRUS EXTENDED SERVICES, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VP OF EXTENDED SERVICES
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:
Authorized Official - Last Name:DONNELLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-847-2969
Mailing Address - Street 1:595 PETERSON DR
Mailing Address - Street 2:
Mailing Address - City:PHILLIPS
Mailing Address - State:WI
Mailing Address - Zip Code:54555-1418
Mailing Address - Country:US
Mailing Address - Phone:715-339-3113
Mailing Address - Fax:715-339-3117
Practice Address - Street 1:595 PETERSON DR
Practice Address - Street 2:
Practice Address - City:PHILLIPS
Practice Address - State:WI
Practice Address - Zip Code:54555-1418
Practice Address - Country:US
Practice Address - Phone:715-339-3113
Practice Address - Fax:715-339-3117
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-24
Last Update Date:2015-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1131314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI20139300Medicaid
WI100003544Medicaid
WI525627Medicare ID - Type Unspecified