Healthcare Provider Details

I. General information

NPI: 1881126977
Provider Name (Legal Business Name): STRAWBERRY LANE NURSING AND REHAB, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2017
Last Update Date: 09/16/2020
Certification Date: 09/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 STRAWBERRY LN
WISCONSIN RAPIDS WI
54494-2156
US

IV. Provider business mailing address

8170 MCCORMICK BLVD STE 112
SKOKIE IL
60076-2961
US

V. Phone/Fax

Practice location:
  • Phone: 715-424-1600
  • Fax:
Mailing address:
  • Phone: 773-825-3336
  • 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: MAX STESEL
Title or Position: MEMBER
Credential:
Phone: 773-825-3336