EXTENDICARE HOMES, INC. (NPI# 1659444883) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1659444883 |
| Entity Type | Organization |
| Organization Name | EXTENDICARE HOMES, INC. |
| Other Organization Name | AMERICAN HERITAGE CARE CENTER |
| Practice Address |
425 Davis St Hammond WI 54015-9615 |
| Mailing Address |
111 W Michigan St Milwaukee WI 53203-2903 |
| Practice Telephone | 7157962218 |
| Practice Fax Number | 7157965286 |
| Mailing Telephone | 4149088119 |
| Mailing Fax Number | 4149087105 |
| Enumeration Date | 2006-11-16 |
| Last Update Date | 2008-04-07 |
| Authorized Official Name | DONNA JO MAASSEN (DIRECTOR OF COMPLIANCE) |
| Authorized Official Telephone | 4149088119 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 314000000X | Skilled Nursing Facility | Nursing & Custodial Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WI | 20179200 | 05 |
| Other Name | Type Code |
|---|---|
| American Heritage Care Center | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1740345800 | Extendicare Homes, Inc. | Assisted Living Facility | 100 E Dalke Ave, Spokane, WA 99208-1006 | 2006-12-27 |
| 1639245558 | Extendicare Homes, Inc. | Skilled Nursing Facility | 1902 Mead Ave, Sheboygan, WI 53081-6140 | 2006-11-24 |
| 1912070624 | Extendicare Homes, Inc. | Skilled Nursing Facility | 414 Robey St, Franklin, KY 42134-1034 | 2006-11-17 |
| 1043383771 | Extendicare Homes, Inc. | Skilled Nursing Facility | 2500 N Elm St, Henderson, KY 42420-2005 | 2006-11-17 |
| 1790859486 | Extendicare Homes, Inc. | Skilled Nursing Facility | 3431 N 13th St, Sheboygan, WI 53083-2938 | 2006-11-17 |
| 1871666560 | Extendicare Homes, Inc. | Skilled Nursing Facility | 1561 Newton Ave, Bowling Green, KY 42104-3238 | 2006-11-17 |
| 1215001862 | Extendicare Homes, Inc. | Skilled Nursing Facility | 619 W Walnut St, Milwaukee, WI 53212-3839 | 2006-11-17 |
| 1619041340 | Extendicare Homes, Inc. | Skilled Nursing Facility | 867 Mcguire Ave, Paducah, KY 42001-4036 | 2006-11-17 |
| 1255405700 | Extendicare Homes, Inc. | Skilled Nursing Facility | 2582 Cerulean Rd, Cadiz, KY 42211-9605 | 2006-11-17 |
| 1376617837 | Extendicare Homes, Inc. | Skilled Nursing Facility | 420 E Grundy Ave, Springfield, KY 40069-1173 | 2006-11-17 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Indiana Business Entities | EXTENDICARE HOMES, INC. | 3500 Lenox Road Ne, Suite 510, Atlanta, GA 30326 |
| Washington State Corporations | EXTENDICARE HOMES, INC. | 3500 Lenox Rd Ne, Suite 510, Atlanta, GA 30326-4229 |
| Street Address |
425 DAVIS ST |
| City | HAMMOND |
| State | WI |
| Zip Code | 54015-9615 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1659971554 | Mariah Marie Diercks | Physical Therapist | 425 Davis St, Hammond, WI 54015-9615 | 2020-10-29 |
| 1356972137 | Brent Alan Nordquist | Occupational Therapy Assistant | 425 Davis St, Hammond, WI 54015-9615 | 2020-01-30 |
| 1982160701 | Amy Elizabeth Gierl | Speech-Language Pathologist | 425 Davis St, Hammond, WI 54015-9615 | 2019-02-17 |
| 1598278988 | Elizabeth Ann Brown | Occupational Therapy Assistant | 425 Davis St, Hammond, WI 54015-9615 | 2017-11-08 |
| 1194243618 | Nsh Hammond LLC | Skilled Nursing Facility | 425 Davis St, Hammond, WI 54015-9615 | 2017-09-05 |
| 1093233827 | Nsh Heritage LLC | Skilled Nursing Facility | 425 Davis St, Hammond, WI 54015-9615 | 2017-08-31 |
| 1770009367 | Breauanna Nina Jennings | Occupational Therapy Assistant | 425 Davis St, Hammond, WI 54015-9615 | 2017-08-16 |
| 1184098477 | Cherri Peterson | Occupational Therapy Assistant | 425 Davis St, Hammond, WI 54015-9615 | 2015-11-24 |
| 1023498235 | Crystal Friske | Occupational Therapy Assistant | 425 Davis St, Hammond, WI 54015-9615 | 2015-06-02 |
| 1104215060 | Fmg Davis Street Snf Wisconsin LLC | Skilled Nursing Facility | 425 Davis St, Hammond, WI 54015-9615 | 2015-01-15 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1184863466 | Daniel Erwin Walth | Dentist | 979 Davis St., Hammond, WI 54015 | 2009-02-11 |
| 1366405391 | Karen Patricia Lindstrom | Registered Nurse | 1853 120th Ave, Hammond, WI 54015-4501 | 2006-04-10 |
| 1659983914 | Rachel Benck | Dental Hygienist | 1089 174th St, Hammond, WI 54015-4831 | 2020-08-18 |
| 1750750014 | Carrie Powell | Physical Therapy Assistant | 981 Eulaine Cir, Hammond, WI 54015-5033 | 2015-09-16 |
| 1154787091 | Glenn Owens | Licensed Practical Nurse | 392 162nd St, Hammond, WI 54015-5222 | 2016-01-07 |
| 1013563113 | Gilhousen Chiropractic Health & Sports Center | Chiropractor | 1025 Davis St, Hammond, WI 54015-9657 | 2019-08-14 |
| 1952325839 | Michael Richard Gilhousen | Chiropractor | 750 Davis St, Hammond, WI 54015-9662 | 2006-07-26 |
| 1982063897 | Cdl Psychological Services, Inc. | Psychologist | 410 Johnson Pkwy, Hammond, WI 54015-9678 | 2016-02-19 |
| 1003305244 | Hailey G Rock | Specialist/Technologist | 1240 Thayer St, Hammond, WI 54015-9741 | 2018-05-03 |
| 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 |
|---|---|---|---|---|
| 1285180158 | Northshore Provider Group LLC | Skilled Nursing Facility | 48529 Red Fox Dr, Hammond, LA 70401-3715 | 2016-08-30 |
| 1194101790 | Diego Puentez | Skilled Nursing Facility | 1117 Summer St, Hammond, IN 46320-2141 | 2015-08-05 |
| 1912079526 | Ns Ng Inc | Skilled Nursing Facility | 501 Old Covington Hwy, Hammond, LA 70403-5126 | 2006-11-15 |
| 1780621193 | Plantation Management Company, LLC | Skilled Nursing Facility | 1300 Derek Dr, Hammond, LA 70403-5765 | 2006-06-02 |
| 1073571212 | Community Care Center of Hammond LLC | Skilled Nursing Facility | 42250 N Oaks Dr, Hammond, LA 70403-4287 | 2006-05-03 |
| 1740761717 | Belle Maison Holdings LLC | Skilled Nursing Facility | 15704 Medical Arts Dr, Hammond, LA 70403-1446 | 2018-08-27 |
| 1457838088 | Belle Maison Nursing & Rehabilitation Center LLC | Skilled Nursing Facility | 15704 Medical Arts Dr, Hammond, LA 70403-1446 | 2018-07-26 |
| 1194243618 | Nsh Hammond LLC | Skilled Nursing Facility | 425 Davis St, Hammond, WI 54015-9615 | 2017-09-05 |
| 1093233827 | Nsh Heritage LLC | Skilled Nursing Facility | 425 Davis St, Hammond, WI 54015-9615 | 2017-08-31 |
| 1104215060 | Fmg Davis Street Snf Wisconsin LLC | Skilled Nursing Facility | 425 Davis St, Hammond, WI 54015-9615 | 2015-01-15 |
| Find all providers in HAMMOND | ||||
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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.