BAY AREA LUTHERAN HOMES INC (NPI# 1780756890) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1780756890 |
| Entity Type | Organization |
| Organization Name | BAY AREA LUTHERAN HOMES INC |
| Other Organization Name | WOODSIDE LUTHERAN HOME |
| Practice Address |
1040 Pilgrim Way Green Bay WI 54304 |
| Practice Telephone | 9204991481 |
| Practice Fax Number | 9204991501 |
| Mailing Telephone | 9204991481 |
| Mailing Fax Number | 9204991501 |
| Enumeration Date | 2006-11-14 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | MRS. JUNE K MECKLENBURG (EXECUTIVE DIRECTOR) |
| Authorized Official Telephone | 9204991481 |
| Authorized Official Credential | NHA |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 314000000X | Skilled Nursing Facility | 2177 | WI | Nursing & Custodial Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WI | 20150200 | 05 |
| Other Name | Type Code |
|---|---|
| Woodside Lutheran Home | Doing Business As Name - Organization |
| Street Address |
1040 PILGRIM WAY |
| City | GREEN BAY |
| State | WI |
| Zip Code | 54304 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982717898 | Tina Meyer | Physical Therapy Assistant | 1040 Pilgrim Way, Green Bay, WI 54304-5028 | 2006-08-16 |
| 1891277299 | Kayla Beth Burton | Occupational Therapist | 1040 Pilgrim Way, Green Bay, WI 54304-5028 | 2018-08-31 |
| 1073030698 | Alisa Irwin | Occupational Therapy Assistant | 1040 Pilgrim Way, Green Bay, WI 54304-5028 | 2017-08-24 |
| 1427339860 | Colleen Elizabeth Schmidt | Physical Therapist | 1040 Pilgrim Way, Green Bay, WI 54304-5028 | 2011-08-30 |
| 1780979724 | Jessica Lynn Atkinson | Physical Therapy Assistant | 1040 Pilgrim Way, Green Bay, WI 54304-5028 | 2011-06-17 |
| 1700184272 | Sarah Crystal Buser | Occupational Therapy Assistant | 1040 Pilgrim Way, Green Bay, WI 54304-5028 | 2011-03-08 |
| 1194022731 | Jennifer Sitzman | Physical Therapy Assistant | 1040 Pilgrim Way, Green Bay, WI 54304 | 2011-02-17 |
| 1184931511 | Kayla Martha Henkel | Occupational Therapy Assistant | 1040 Pilgrim Way, Green Bay, WI 54304-5028 | 2010-09-07 |
| 1932410446 | Joan F Thiede | Physical Therapy Assistant | 1040 Pilgrim Way, Woodside Lutheran Home, Green Bay, WI 54304 | 2010-06-30 |
| 1912237611 | Karla Flores | Occupational Therapy Assistant | 1040 Pilgrim Way, Green Bay, WI 54304-5028 | 2010-01-04 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1689196255 | Kristen Ashley Haltom | Registered Nurse | 2979 Allied St Suite C, Green Bay, WI 54304 | 2017-07-14 |
| 1649671421 | Heather Marie Novak | Counselor | 2979 Allied St Unit C, Green Bay, WI 54304 | 2014-09-11 |
| 1356777684 | Nathan Weir | Specialist/Technologist | 1265 Lombardi Avenue, Green Bay, WI 54304 | 2013-09-18 |
| 1922349927 | John W Hartman | Internal Medicine | 916 Willard Dr, Suite 200, Green Bay, WI 54304 | 2013-03-15 |
| 1447551379 | Citralina M Haruo | Community Health Worker | 1110 11th Avenue, Green Bay, WI 54304 | 2010-11-09 |
| 1497061352 | Daniel James Gustin | Pharmacist | 1109 Lombardi Ave, Green Bay, WI 54304 | 2010-08-28 |
| 1316259898 | Karen A Detrick | Occupational Therapy Assistant | 1040 Pilgram Way, Woodside Senior Communities, Green Bay, WI 54304 | 2010-07-13 |
| 1861667362 | Planned Parenthood of Wi, Inc | Non-Pharmacy Dispensing Site | 2605 S. Oneida St. Suite 107, Green Bay, WI 54304 | 2008-04-25 |
| 1891967303 | Kimberley M Welk | Marriage & Family Therapist | 926 Willard Dr Ste 136, Green Bay, WI 54304 | 2008-03-25 |
| 1750563698 | Richard Lawrence Beyer | Hearing Instrument Specialist | 2154 S Ridge Rd, Green Bay, WI 54304 | 2007-12-03 |
| Find all providers in zip 54304 | ||||
| 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 |
|---|---|---|---|---|
| 1659736478 | Crystal Fountains Rehabilitation Center LLC | Skilled Nursing Facility | 403 South Clay St, Green Bay, WI 54301-3807 | 2015-12-21 |
| 1588839492 | San Luis Medical & Rehab Center | Skilled Nursing Facility | 2305 San Luis Pl, Green Bay, WI 54304-5211 | 2008-04-23 |
| 1366489171 | Parkview Manor Healthcare LLC | Skilled Nursing Facility | 2961 Saint Anthony Dr, Green Bay, WI 54311-5860 | 2006-06-01 |
| 1225085640 | Beverly Enterprises - Wisconsin, Inc | Skilled Nursing Facility | 1640 Shawano Ave, Green Bay, WI 54303-3214 | 2006-05-30 |
| 1366498388 | Manor Care of Green Bay Wi (east) LLC | Skilled Nursing Facility | 600 S Webster Ave, Green Bay, WI 54301-3503 | 2006-05-25 |
| 1124006739 | Odd Fellow Rebekah Home Association Inc | Skilled Nursing Facility | 1207 S Jackson St, Green Bay, WI 54301-3037 | 2006-01-04 |
| 1578559456 | Santa Maria Nursing Home, Inc. | Skilled Nursing Facility | 430 S Clay St, Green Bay, WI 54301-3807 | 2005-09-26 |
| 1851385231 | Bornemann Nursing Home Inc | Skilled Nursing Facility | 226 Bornemann St, Green Bay, WI 54302 | 2005-08-31 |
| 1689671109 | Zunker Health Care Inc | Skilled Nursing Facility | 1555 Dousman St, Green Bay, WI 54303-3207 | 2005-06-30 |
| 1104394758 | Parkview Nursing and Rehab, LLC | Skilled Nursing Facility | 2961 Saint Anthony Dr, Green Bay, WI 54311-5860 | 2018-11-12 |
| Find all providers in GREEN BAY | ||||
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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.