OrganizationActive
Medicaid
NPI 1336109776 · Custodial Care Facility · Menasha, WI
Provider details
- NPI number
- 1336109776
- Entity type
- Organization
- Primary specialty
- Custodial Care FacilityNursing & Custodial Care Facilities
- Organization subpart
- No
- Authorized official
- Lori Farragh, RN(920) 450-8323
Specialties & taxonomies
Nursing & Custodial Care Facilities
- Pediatric Skilled Nursing Facility3140N1450X
Nursing & Custodial Care Facilities
Practice location
1125 Geneva Rd
Menasha, WI 54952-1505
Phone: (920) 450-8323
Approximate (ZIP-level) locationGet directions
Mailing address
1125 Geneva Rd
Menasha, WI 54952-1505
Registry dates
- Enumerated
- 2006-03-27
- Last updated
- 2025-09-11
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.