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General NPI Number Information
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NPI Number | 1164242731
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Entity Type | Organization
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Legal Business Name | CLEARSKY REHABILITATION HOSPITAL LAKESHORE LLC
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Dates
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Enumeration Date | 10/16/2024
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Last Update Date | 07/01/2025
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Provider Practice Location Address
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Address Line | 1330 WILLOW WAY
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City | CLEVELAND
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State | WI
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Zip | 53015-1216
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Country | US
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Telephone | 920-626-4530
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Fax |
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Provider Business Mailing Address
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Address Line | 5600 WYOMING BLVD NE STE 225
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City | ALBUQUERQUE
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State | NM
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Zip | 87109-3136
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Country | US
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Telephone | 505-317-3802
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Fax |
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Authorized Official
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Title or Position | CFO
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Name | KRISTI DUNCAN
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Credential |
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Telephone | 505-317-3988
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 283X00000X
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Taxonomy Name | Rehabilitation Hospital
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License Number |
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License Number State |
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