MEDICAID (NPI# 1336109776) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1336109776 |
| Entity Type | Organization |
| Organization Name | MEDICAID |
| Practice Address |
1125 Geneva Rd Menasha WI 54952-1505 |
| Practice Telephone | 9204508323 |
| Mailing Telephone | 9204508323 |
| Enumeration Date | 2006-03-27 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | MISS LORI ANN FARRAGH (RN) |
| Authorized Official Telephone | 9204508323 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| X | 3140N1450X |
Skilled Nursing Facility Specialization: Nursing Care, Pediatric |
WI | Nursing & Custodial Care Facilities | |
| X | 311Z00000X | Custodial Care Facility | WI | Nursing & Custodial Care Facilities |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609990712 | Medicaid | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 329 W Jamaica Ave, Valley Stream, NY 11580-5322 | 2007-03-16 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Oregon Corporations, Companies and Business Names | MEDICAID ADJUDICATION SERVICES, INC. | 545 S 4th Street, Coos Bay, OR 97420 |
| Connecticut Business Registrations | MEDICAID AMERICA LLC | 42 Lincoln Ave, Norwalk, CT 06854 |
| Colorado Business Entities | Medicaid Consulting Group, LLC | 665 Southpointe Ct, Suite 100, Colorado Springs, CO 80906 |
| Connecticut Business Registrations | Medicaid Done Right LLC | 13825 Icot Blvd., Suite 611, Clearwater, FL 33760 |
| Iowa Business Entities | MEDICAID DONE RIGHT LLC | 13825 Icot Blvd Suite 611, Clearwater, FL 33760 |
| Indiana Business Entities | MEDICAID DONE RIGHT LLC | 2560 Gulf To Bay Blvd., Suite 300, Clearwater, FL 33765 |
| Virginia Business Entities | MEDICAID DONE RIGHT LLC | 2560 Gulf To Bay Blvd #300, Clearwater, Florida 33765 |
| System for Award Management (SAM) Entities | MEDICAID FRAUD CONTROL UNIT | 200 St Paul Pl 18th Fl, Baltimore, MD 21202-2004 |
| New York State Corporations | MEDICAID MANAGED CARE PROGRAMS OF NEW YORK STATE, INC. | 420 Lakeville Road, Lake Success, Ny 11042 |
| New York State Corporations | MEDICAID MANAGEMENT CORP. | 620 Ulster Landing Road, Saugerties, Ny 12477 |
| Street Address |
1125 GENEVA RD |
| City | MENASHA |
| State | WI |
| Zip Code | 54952-1505 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1275776239 | Sharon Louise Crowe | Dental Hygienist | 1814 North Appleton Road, Menasha, WI 54952 | 2009-04-07 |
| 1003056110 | Nicole Marie Guyette | Dental Hygienist | 814 N. Appleton Road, Menasha, WI 54952 | 2009-03-02 |
| 1760627624 | Jan Charles Sarnecki | Orthopaedic Surgery | 1814 N. Appleton Road, Menasha, WI 54952 | 2008-12-08 |
| 1588828297 | Lesley R Lathrop | Registered Nurse | 1764 Oakridge Court, Menasha, WI 54952 | 2008-07-11 |
| 1699965137 | Lisa Randerson | Counselor | 1427c Province Terrace, Menasha, WI 54952 | 2007-07-31 |
| 1689748675 | Lisa Lynn Lang Riegel | Dentist | 1155 Wittman Drive, Menasha, WI 54952 | 2006-11-20 |
| 1164596144 | Robert Charles Lang | Dentist | 1155 Wittmann Drive, Menasha, WI 54952 | 2006-11-20 |
| 1366527947 | Karen Patricia Schmidt | Case Manager/Care Coordinator | 1810 Appleton Road, Menasha, WI 54952 | 2006-10-25 |
| 1376647388 | Goodwill Industries of North Central Wi | Counselor | 1800 Appleton Road, Menasha, WI 54952 | 2006-09-11 |
| 1386135614 | Leslie J Steckbauer | Counselor | 1095 Midway Rd, Menasha, WI 54952 | 2018-05-22 |
| Find all providers in zip 54952 | ||||
| Taxonomy Code | 3140N1450X |
| Grouping | Nursing & Custodial Care Facilities |
| Classification | Skilled Nursing Facility |
| Specialization | Nursing Care, Pediatric |
| A nursing care facility designed and staffed for the provision of nursing care and appropriate educational and habilitative/rehabilitative services to children with multiple, complex or profound disabilities that can not be cared for in a less restrictive environment. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1154869410 | Jacksonscott2 | Skilled Nursing Facility | 4573 N. 22nd Street, Milwaukee, WI 53209 | 2017-02-07 |
| 1720450125 | Independent Nursing | Skilled Nursing Facility | 143 E Pine Hollow Ln Apt 1, Oak Creek, WI 53154-7714 | 2015-10-24 |
| 1528472024 | Colleen L Biller | Skilled Nursing Facility | 1421 S 17th St, Sheboygan, WI 53081-5123 | 2014-06-12 |
| 1154754620 | Private Duty Nursing Service | Skilled Nursing Facility | 1538 Troy Dr Apt 1, Madison, WI 53704-2074 | 2013-08-19 |
| 1023367612 | Johnnie Mae Simmons | Skilled Nursing Facility | 4560 N. 40th St, Milwaukee, WI 53209 | 2012-08-29 |
| 1629302872 | Ashley Zimdahl | Skilled Nursing Facility | N2364 Sunset Dr, Campbellsport, WI 53010-2038 | 2009-09-21 |
| 1760634729 | Regina Angela Lanza | Skilled Nursing Facility | W193s7842 Overlook Bay Rd # 6d, Muskego, WI 53150-7813 | 2008-10-21 |
| 1881865012 | Lisa Salaway | Skilled Nursing Facility | 510 Cabrillo Ct, Verona, WI 53593-8233 | 2008-03-16 |
| 1538353982 | Wisconsin Medicaid | Skilled Nursing Facility | 1528 Remington Rd, Neenah, WI 54956-1696 | 2007-08-29 |
| 1336340561 | Badgerland Billing LLC | Skilled Nursing Facility | 2632 Smithfield Dr, Fitchburg, WI 53719-1665 | 2007-05-28 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.