Healthcare Provider Details

I. General information

NPI: 1669647673
Provider Name (Legal Business Name): SAN LUIS MEDICAL & REHAB
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2008
Last Update Date: 04/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2305 SAN LUIS PL
GREEN BAY WI
54304-5211
US

IV. Provider business mailing address

2915 SHADE TREE LN
GREEN BAY WI
54313-7081
US

V. Phone/Fax

Practice location:
  • Phone: 920-494-5231
  • Fax:
Mailing address:
  • Phone: 920-621-3822
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MRS. ANDREA MARIE SHEEDY
Title or Position: COTA
Credential:
Phone: 920-494-5231