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General NPI Number Information
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NPI Number | 1306300694
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Entity Type | Organization
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Legal Business Name | DIVINE REHABILITATION AND NURSING AT FENNIMORE LLC
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Dates
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Enumeration Date | 01/30/2019
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Last Update Date | 01/14/2025
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Provider Practice Location Address
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Address Line | 1850 11TH ST
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City | FENNIMORE
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State | WI
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Zip | 53809-1612
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Country | US
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Telephone | 608-822-6100
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Fax |
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Provider Business Mailing Address
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Address Line | 1632 61ST ST
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City | BROOKLYN
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State | NY
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Zip | 11204-2109
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Country | US
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Telephone | 608-448-6200
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | ISAAK MARKOVITS
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Credential |
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Telephone | 718-753-0250
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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 |
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