Healthcare Provider Details

I. General information

NPI: 1629504352
Provider Name (Legal Business Name): THE BAY AT SHERIDAN HEALTH AND REHABILITATION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2017
Last Update Date: 09/08/2023
Certification Date: 09/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8400 SHERIDAN RD
KENOSHA WI
53143
US

IV. Provider business mailing address

8400 SHERIDAN RD
KENOSHA WI
53143-6327
US

V. Phone/Fax

Practice location:
  • Phone: 262-658-4141
  • Fax:
Mailing address:
  • Phone: 262-658-4141
  • 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: MENACHEM RUVEL
Title or Position: MANAGER
Credential:
Phone: 516-605-9800