MEDICARE: GLENDALE CARE AND REHAB CENTER LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility

General Provider Information

NPI Number	:	1164005732
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GLENDALE CARE AND REHAB CENTER LLC

Provider Business Mailing Address
First Line	:	6263 N GREEN BAY AVE
Second Line	:
City	:	GLENDALE
State	:	WI
Zip	:	53209-3823
Country	:	US
Telephone Number	:	414-351-0543
Fax Number	:

Provider Business Practice Location Address
First Line	:	6263 N GREEN BAY AVE
Second Line	:
City	:	GLENDALE
State	:	WI
Zip	:	53209-3823
Country	:	US
Telephone Number	:	414-351-0543
Fax Number	:

Authorized Official
Title or Position	:	AUTHORIZED SIGNER
Name	:	SHALOM STEIN
Credential	:
Telephone Number	:	732-313-0880

Provider Enumeration Date	:	05/03/2021
Last Update Date	:	01/29/2026

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