Healthcare Provider Details

I. General information

NPI: 1386644672
Provider Name (Legal Business Name): OAK RIDGE CARE CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

438 ASHFORD AVE
LOMIRA WI
53048-9578
US

IV. Provider business mailing address

PO BOX 280 438 ASHFORD AVE
LOMIRA WI
53048-0280
US

V. Phone/Fax

Practice location:
  • Phone: 920-269-4386
  • Fax: 920-269-4978
Mailing address:
  • Phone: 920-269-4386
  • Fax: 920-269-4978

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number3222
License Number StateWI

VIII. Authorized Official

Name: MR. STEVEN D KURANZ
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 920-269-4386