Basic Information
Provider Information
NPI: 1629106570
EntityType: 2
ReplacementNPI:  
OrganizationName: CALUMET HOMESTEAD REHABILITATION CENTER
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1712 MONROE ST
Address2:  
City: NEW HOLSTEIN
State: WI
PostalCode: 530611307
CountryCode: US
TelephoneNumber: 9208984296
FaxNumber: 9208984931
Practice Location
Address1: 1712 MONROE ST
Address2:  
City: NEW HOLSTEIN
State: WI
PostalCode: 530611307
CountryCode: US
TelephoneNumber: 9208984296
FaxNumber: 9208984931
Other Information
ProviderEnumerationDate: 03/01/2007
LastUpdateDate: 08/22/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: ANHALT
AuthorizedOfficialFirstName: DEBRA
AuthorizedOfficialMiddleName: J
AuthorizedOfficialTitleorPosition: OFFICE MANAGER
AuthorizedOfficialTelephone: 9208984296
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix: MRS.
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
314000000X2366WIY Nursing & Custodial Care FacilitiesSkilled Nursing Facility 

ID Information
IDTypeStateIssuerDescription
2013340005WI MEDICAID


Home