CCG - FREDERIC (NPI# 1366440430) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1366440430 |
| Entity Type | Organization |
| Organization Name | CCG - FREDERIC |
| Other Organization Name | FREDERIC NURSING AND REHABILITATION COMMUNITY |
| Practice Address |
205 United Way Frederic WI 54837-8938 |
| Mailing Address |
5000 Hakes Dr Suite 600 Norton Shores MI 49441-5574 |
| Practice Telephone | 7153274297 |
| Practice Fax Number | 7153274950 |
| Mailing Telephone | 2317996870 |
| Mailing Fax Number | 2317990250 |
| Enumeration Date | 2005-07-12 |
| Last Update Date | 2008-04-20 |
| Authorized Official Name | KEITH YODER (CFO) |
| Authorized Official Telephone | 6144160600 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 314000000X | Skilled Nursing Facility | 3086 | WI | Nursing & Custodial Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WI | 20191100 | 05 |
| Other Name | Type Code |
|---|---|
| Frederic Nursing and Rehabilitation Community | Doing Business As Name - Organization |
| Street Address |
205 UNITED WAY |
| City | FREDERIC |
| State | WI |
| Zip Code | 54837-8938 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1245880533 | Kyle Steffen | Physical Therapy Assistant | 205 United Way, Frederic, WI 54837-8938 | 2019-09-18 |
| 1194378224 | Lisa Marie Flanagan | Occupational Therapy Assistant | 205 United Way, Frederic, WI 54837-8938 | 2019-07-17 |
| 1487122040 | David Foss | Physical Therapy Assistant | 205 United Way, Frederic, WI 54837-8938 | 2018-11-12 |
| 1073882684 | Leah Luanne Williams | Skilled Nursing Facility | 205 United Way, Frederic, WI 54837-8938 | 2011-12-28 |
| 1700155090 | Kandis Joy Olson | Occupational Therapist | 205 United Way, Frederic, WI 54837-8938 | 2011-12-15 |
| 1255636890 | Laurie A Breeden | Physical Therapy Assistant | 205 United Way, Frederic, WI 54837-8938 | 2011-01-12 |
| 1477858017 | Debra Irene Erwin | Occupational Therapy Assistant | 205 United Way, Frederic, WI 54837-8938 | 2011-01-12 |
| 1528246626 | Orion Frederic LLC | Skilled Nursing Facility | 205 United Way, Frederic, WI 54837-8938 | 2008-01-31 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548639636 | Austin Ross | Pharmacist | 201 Oak St West, Frederic, WI 54837 | 2015-09-18 |
| 1811256126 | St. Croix Regional Medical Center | Clinic/Center | 205 West Oak Street, Frederic, WI 54837 | 2012-05-07 |
| 1447497763 | Saint-mark Enterprises 1855 LLC | Durable Medical Equipment & Medical Supplies | 110 E Oak St, Frederic, WI 54837 | 2009-01-08 |
| 1639263221 | Pharmacy Operations Inc | Pharmacy | 110 E Oak Street, Frederic, WI 54837 | 2006-10-03 |
| 1457338139 | Joseph L Marek | Chiropractor | 101 United Way, Frederic, WI 54837 | 2005-12-23 |
| 1669572590 | Steven Richard Tesch | Dentist | 106 S Wisconsin Ave, Frederic, WI 54837-0250 | 2006-09-22 |
| 1306946223 | Bradley Scott Harlander | Dentist | 106 S Wisconsin Ave, Frederic, WI 54837-0250 | 2006-09-22 |
| 1689004426 | Kristina M Thompson | Social Worker | 107 Hope Road West, Frederic, WI 54837-0383 | 2013-11-14 |
| 1588158679 | Hope Road Wellness Center, LLC | Social Worker | 107 Hope Road West, Frederic, WI 54837-0383 | 2018-06-21 |
| 1043499734 | School District of Frederic | Local Education Agency (LEA) | 1437 Clam Falls Dr, Frederic, WI 54837-4547 | 2007-10-30 |
| Find all providers in zip 54837 | ||||
| Taxonomy Code | 314000000X |
| Grouping | Nursing & Custodial Care Facilities |
| Classification | Skilled Nursing Facility |
| (1) A skilled nursing facility is a facility or distinct part of an institution whose primary function is to provide medical, continuous nursing, and other health and social services to patients who are not in an acute phase of illness requiring services in a hospital, but who require primary restorative or skilled nursing services on an inpatient basis above the level of intermediate or custodial care in order to reach a degree of body functioning to permit self care in essential daily living. It meets any licensing or certification standards et forth by the jurisdiction where it is located. A skilled nursing facility may be a freestanding facility or part of a hospital that has been certified by Medicare to admit patients requiring subacute care and rehabilitation; (2) Provides non-acute medical and skilled nursing care services, therapy and social services under the supervision of a licensed registered nurse on a 24-hour basis. |
| Notes: Source: (1) "Glossary of terms used in managed care" Developed by the Managed Care Assembly (MCA) of Medical Group Management Association (MGMA), MGM Journal, September/October 1995, p. 64; (2) AHA Guide, 1996 Annual Survey. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1073882684 | Leah Luanne Williams | Skilled Nursing Facility | 205 United Way, Frederic, WI 54837-8938 | 2011-12-28 |
| 1528246626 | Orion Frederic LLC | Skilled Nursing Facility | 205 United Way, Frederic, WI 54837-8938 | 2008-01-31 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356962369 | Heritage Assisted Living, LLC | Skilled Nursing Facility | 5020 S 107th St, Greenfield, WI 53228-3267 | 2020-04-30 |
| 1235762881 | Imr Oak Creek Opco, LLC | Skilled Nursing Facility | 2700 West Honadel Boulevard, Oak Creek, WI 53154 | 2020-02-21 |
| 1831693936 | Golden Years Nursing Home, Inc. | Skilled Nursing Facility | 611 Harmony Dr, Lake Geneva, WI 53147-8800 | 2018-03-22 |
| 1801302732 | Oak Park Place of Janesville, LLC | Skilled Nursing Facility | 700 Myrtle Way, Janesville, WI 53545-9101 | 2017-12-14 |
| 1235674839 | Zachary Rader | Skilled Nursing Facility | 645 N Church St, Elkhorn, WI 53121-2204 | 2017-01-05 |
| 1982155248 | The Bethany-st. Joseph Corporation D/b/a Prairie Pointe Rehab Suites | Skilled Nursing Facility | 286 N. Willson Dr, Altoona, WI 54720 | 2016-10-20 |
| 1316492317 | Darcy Christiansen | Skilled Nursing Facility | 4427 E Pic A Dilly Dr, Janesville, WI 53546-9606 | 2016-08-19 |
| 1366895583 | Jeffrey Alan Weinshrott | Skilled Nursing Facility | 336 Wisconsin Ave, Sheboygan, WI 53081-4183 | 2016-07-22 |
| 1720433378 | Kendra Meyers | Skilled Nursing Facility | 1806 N Hume Ave Apt 4, Marshfield, WI 54449-1677 | 2016-05-02 |
| 1952756991 | Grace Lutheran Foundation Inc | Skilled Nursing Facility | 206 North Willson Drive, Altoona, WI 54720 | 2016-04-27 |
| 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.