Healthcare Provider Details

I. General information

NPI: 1669513560
Provider Name (Legal Business Name): BENEVOLENT CORPORATION CEDAR COMMUNITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2007
Last Update Date: 09/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5595 COUNTY ROAD Z
WEST BEND WI
53095-9224
US

IV. Provider business mailing address

5595 COUNTY ROAD Z
WEST BEND WI
53095-9224
US

V. Phone/Fax

Practice location:
  • Phone: 262-306-2100
  • 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: MR. CHRISTOPHER CHERNEY
Title or Position: CFO
Credential:
Phone: 262-306-4212