Basic Information
| Provider Information | |||||||||
| NPI: | 1609426337 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | OCONTO FALLS NURSING AND REHAB LLC | ||||||||
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| OtherOrganizationName: | MEADOWBROOK AT OCONTO FALLS | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8170 MCCORMICK BLVD STE 119 | ||||||||
| Address2: | |||||||||
| City: | SKOKIE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600762961 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8479427575 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 100 E HIGHLAND DR | ||||||||
| Address2: | |||||||||
| City: | OCONTO FALLS | ||||||||
| State: | WI | ||||||||
| PostalCode: | 541541001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9208483272 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/15/2019 | ||||||||
| LastUpdateDate: | 02/03/2022 | ||||||||
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| AuthorizedOfficialLastName: | PUKSHANSKY | ||||||||
| AuthorizedOfficialFirstName: | ROSTISLAV | ||||||||
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| AuthorizedOfficialTitleorPosition: | PARTNER | ||||||||
| AuthorizedOfficialTelephone: | 8479427575 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 02/03/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
No ID Information.