Healthcare Provider Details

I. General information

NPI: 1629496039
Provider Name (Legal Business Name): PSCN, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2014
Last Update Date: 09/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 E HIGHLAND DR
OCONTO FALLS WI
54154-1001
US

IV. Provider business mailing address

7444 LONG AVE
SKOKIE IL
60077-3214
US

V. Phone/Fax

Practice location:
  • Phone: 920-848-3272
  • Fax:
Mailing address:
  • Phone: 847-329-4100
  • 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: BENJAMIN KLEIN
Title or Position: MANAGER
Credential:
Phone: 847-329-4100