Healthcare Provider Details

I. General information

NPI: 1265420319
Provider Name (Legal Business Name): SUN PRAIRIE HEALTH CARE CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2005
Last Update Date: 01/31/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

228 W MAIN ST
SUN PRAIRIE WI
53590-2908
US

IV. Provider business mailing address

228 W MAIN ST
SUN PRAIRIE WI
53590-2908
US

V. Phone/Fax

Practice location:
  • Phone: 608-251-1171
  • Fax: 608-825-4390
Mailing address:
  • Phone: 608-251-1171
  • Fax: 608-825-4390

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number2598
License Number StateWI

VIII. Authorized Official

Name: MR. EDWIN M. KRUCHTEN
Title or Position: OWNER
Credential:
Phone: 608-849-5016