Healthcare Provider Details

I. General information

NPI: 1285093344
Provider Name (Legal Business Name): STRAWBERRY LANE MANAGEMENT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/17/2016
Last Update Date: 02/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 STRAWBERRY LN
WISCONSIN RAPIDS WI
54494-2156
US

IV. Provider business mailing address

170 BROADWAY
LAWRENCE NY
11559-1731
US

V. Phone/Fax

Practice location:
  • Phone: 715-424-1600
  • 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: GERALD STOLL
Title or Position: MANAGER
Credential:
Phone: 917-836-0436