Healthcare Provider Details

I. General information

NPI: 1861796492
Provider Name (Legal Business Name): FAMILY HERITAGE NURSING & REHABILITATION CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/22/2010
Last Update Date: 07/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1311 TYLER ST
BLACK RIVER FALLS WI
54615-1564
US

IV. Provider business mailing address

1311 TYLER ST
BLACK RIVER FALLS WI
54615-1564
US

V. Phone/Fax

Practice location:
  • Phone: 715-284-4396
  • Fax: 715-284-7786
Mailing address:
  • Phone: 715-284-4396
  • Fax: 715-284-7786

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number3211
License Number StateWI

VIII. Authorized Official

Name: MOSHE ORLINSKY
Title or Position: MANAGING MEMBER
Credential:
Phone: 314-588-7518