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General NPI Number Information
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NPI Number | 1174949663
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Entity Type | Organization
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Legal Business Name | WOODSTOCK HEALTH CARE LLC
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Dates
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Enumeration Date | 03/09/2014
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Last Update Date | 12/02/2015
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Provider Practice Location Address
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Address Line | 3415 SHERIDAN RD
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City | KENOSHA
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State | WI
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Zip | 53140-1924
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Country | US
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Telephone | 262-657-6175
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Fax | 262-653-8441
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Provider Business Mailing Address
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Address Line | 3415 SHERIDAN RD
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City | KENOSHA
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State | WI
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Zip | 53140-1924
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Country | US
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Telephone | 262-657-6175
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Fax | 262-653-8441
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Authorized Official
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Title or Position | CONSULTANT
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Name | JUDAH BIENSTOCK
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Credential |
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Telephone | 314-631-3000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number |
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License Number State | WI
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