Healthcare Provider Details

I. General information

NPI: 1174375729
Provider Name (Legal Business Name): OAK CREEK HEALTH AND REHABILITATION CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2024
Last Update Date: 04/04/2024
Certification Date: 04/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 W HONADEL BLVD
OAK CREEK WI
53154-2650
US

IV. Provider business mailing address

165 N VILLAGE AVE STE 126
ROCKVILLE CENTRE NY
11570-3763
US

V. Phone/Fax

Practice location:
  • Phone: 414-435-2005
  • Fax:
Mailing address:
  • Phone: 516-605-9800
  • 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: MR. MENACHEM RUVEL
Title or Position: MANAGING MEMBER
Credential:
Phone: 516-605-9800