Basic Information
| Provider Information | |||||||||
| NPI: | 1467941070 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BELOIT NURSING AND REHAB, LLC | ||||||||
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| OtherOrganizationName: | EDENBROOK OF BELOIT | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8170 MCCORMICK BLVD STE 112 | ||||||||
| Address2: | |||||||||
| City: | SKOKIE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600762914 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7738253336 | ||||||||
| FaxNumber: | 8474236991 | ||||||||
| Practice Location | |||||||||
| Address1: | 1905 W HART RD | ||||||||
| Address2: | |||||||||
| City: | BELOIT | ||||||||
| State: | WI | ||||||||
| PostalCode: | 535112230 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6083652554 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/09/2018 | ||||||||
| LastUpdateDate: | 05/09/2018 | ||||||||
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| AuthorizedOfficialLastName: | PUKSHANSKY | ||||||||
| AuthorizedOfficialFirstName: | ROSTISLAV | ||||||||
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| AuthorizedOfficialTitleorPosition: | CORPORATE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 7738253336 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | WI | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
No ID Information.