Healthcare Provider Details

I. General information

NPI: 1164072898
Provider Name (Legal Business Name): BRF NURSING AND REHAB LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2019
Last Update Date: 02/03/2022
Certification Date: 02/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1311 TYLER ST
BLACK RIVER FALLS WI
54615-1564
US

IV. Provider business mailing address

8170 MCCORMICK BLVD STE 119
SKOKIE IL
60076-2961
US

V. Phone/Fax

Practice location:
  • Phone: 715-284-4396
  • Fax:
Mailing address:
  • Phone: 847-942-7575
  • 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: ROSTISLAV PUKSHANSKY
Title or Position: PARTNER
Credential:
Phone: 847-942-7575