Shady Lane Home, Inc.

LBN: Shady Lane Home, Inc.
Shady Lane Home, Inc. is an health care organization with primary practice located at 1235 S 24Th St , Manitowoc WI 54220-5516. The organization recently has only one registered license in Nursing & Custodial Care Facilities / Skilled Nursing Facility, which is considered as the primary health care specialty. Shady Lane Home, Inc. can be contacted via phone (920) 682-8254, or through Wetenkamp, Lisa M via phone (920) 682-8254.

Contact Information

Primary practice address
1235 S 24Th St Manitowoc WI 54220-5516
Phone: (920) 682-8254
Fax: (920) 682-8315
Website:
Map and Directions
Authorized official contact:
Name: Wetenkamp, Lisa M
Phone: (920) 682-8254

Health care specialties

SpecialtyCodeLicense #State
Nursing & Custodial Care Facilities / Skilled Nursing Facility 314000000X 2250 Wisconsin

Profile Details

NPI number 1518926211
LBN Legal business name Shady Lane Home, Inc.
DBA Doing business as
Authorized official Wetenkamp, Lisa M
Entity Organization
Organization subpart 1 No
Enumeration date Mar 21st, 2006
Last updated Dec 31st, 2020 - about 5 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1518926211 NPPES
Wisconsin MEDICAID 20158400

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