Provider Demographics
NPI:1154514511
Name:SENIOR MANAGEMENT INC
Entity type:Organization
Organization Name:SENIOR MANAGEMENT INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GRANT
Authorized Official - Middle Name:DONALD
Authorized Official - Last Name:THAYER
Authorized Official - Suffix:
Authorized Official - Credentials:NHA
Authorized Official - Phone:507-269-6815
Mailing Address - Street 1:104 E DALLAS ST
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:WI
Mailing Address - Zip Code:54733-9699
Mailing Address - Country:US
Mailing Address - Phone:715-837-1222
Mailing Address - Fax:715-837-1538
Practice Address - Street 1:104 E DALLAS ST
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:WI
Practice Address - Zip Code:54733-9699
Practice Address - Country:US
Practice Address - Phone:715-837-1222
Practice Address - Fax:715-837-1538
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SENIOR MANAGEMENT INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-08-20
Last Update Date:2007-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3039314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI20199100Medicaid