Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Medicaid

Organization Custodial Care Facility · NPI 1336109776

Medicaid is a Custodial Care Facility in Menasha, Wisconsin. Licensed in Wisconsin. Registered with an NPI since 2006.

Licensed in
WI
In the registry since
2006
Specialties on file
2

Practice location Address checks out

1125 Geneva Rd
Menasha, WI 54952-1505
Phone: (920) 450-8323
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Custodial Care Facility (primary) Taxonomy 311Z00000X (WI)
Pediatric Skilled Nursing Facility Taxonomy 3140N1450X (WI)

Record details

NPI number1336109776
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Lori Farragh — Rn · (920) 450-8323
NPI enumeratedMarch 27, 2006
Last updated in NPPESSeptember 11, 2025
Mailing address1125 Geneva Rd, Menasha, WI 54952-1505