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NPI Code Detail

MEDICARE: GRANDE PRAIRIE CARE AND REHAB CENTER LLC

MEDICARE: GRANDE PRAIRIE 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
1314000000XSkilled Nursing Facility

General Provider Information

NPI Number : 1912643834
Entity Type Code : Organization
Provider Name (Legal Business Name) : GRANDE PRAIRIE CARE AND REHAB CENTER LLC
Provider Business Mailing Address
First Line : 10330 PRAIRIE RIDGE BLVD
Second Line :
City : PLEASANT PRAIRIE
State : WI
Zip : 53158-1947
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 10330 PRAIRIE RIDGE BLVD
Second Line :
City : PLEASANT PRAIRIE
State : WI
Zip : 53158-1947
Country : US
Telephone Number : 262-612-2800
Fax Number :
Authorized Official
Title or Position : OWNER
Name : SHALOM STEIN
Credential :
Telephone Number : 732-313-0880
Provider Enumeration Date : 05/12/2022
Last Update Date : 05/01/2026

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Directions to “GRANDE PRAIRIE CARE AND REHAB CENTER LLC ” Practice Location

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