Healthcare Provider Details

I. General information

NPI: 1154971364
Provider Name (Legal Business Name): BEDROCK HCS AT ABBOTSFORD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2019
Last Update Date: 09/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 E ELM ST
ABBOTSFORD WI
54405-9682
US

IV. Provider business mailing address

WORKSPACE AT BITBEAN 1776 AVE OF THE STATES SUITE 302 C/O ESTHER TILLIM
LAKEWOOD NJ
08701
US

V. Phone/Fax

Practice location:
  • Phone: 715-223-2359
  • Fax:
Mailing address:
  • Phone: 732-328-7499
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: ESTHER TILLIM
Title or Position: BOOKKEEPER
Credential:
Phone: 732-328-7499