Healthcare Provider Details

I. General information

NPI: 1346763729
Provider Name (Legal Business Name): COMPLETE CARE AT RIDGEWOOD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2017
Last Update Date: 07/31/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3205 WOOD RD
RACINE WI
53406-5048
US

IV. Provider business mailing address

3205 WOOD RD
RACINE WI
53406-5048
US

V. Phone/Fax

Practice location:
  • Phone: 262-554-6440
  • Fax:
Mailing address:
  • Phone:
  • 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: SHALOM STEIN
Title or Position: AUTHORIZED REPRESENTATIVE
Credential:
Phone: 732-313-0880