Healthcare Provider Details

I. General information

NPI: 1730643107
Provider Name (Legal Business Name): DIVINE REHABILITATION AND NURSING AT ST CROIX LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2019
Last Update Date: 08/28/2023
Certification Date: 08/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 E LOUISIANA ST
SAINT CROIX FALLS WI
54024-9501
US

IV. Provider business mailing address

1632 61ST ST
BROOKLYN NY
11204-2109
US

V. Phone/Fax

Practice location:
  • Phone: 715-483-9815
  • 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: ISAAK MARKOVITS
Title or Position: MANAGING MEMBER
Credential:
Phone: 718-753-0250