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General NPI Number Information
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NPI Number | 1568686129
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Entity Type | Organization
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Legal Business Name | BEECHWOOD REST HOME
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Dates
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Enumeration Date | 04/12/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | N1495W HIGHWAY A
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City | KEWASKUM
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State | WI
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Zip | 53040-9205
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Country | US
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Telephone | 920-994-4717
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Fax | 920-994-4932
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Provider Business Mailing Address
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Address Line | N1495W HIGHWAY A
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City | KEWASKUM
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State | WI
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Zip | 53040-9205
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Country | US
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Telephone | 920-994-4717
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Fax | 920-994-4932
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Authorized Official
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Title or Position | NHA
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Name | MR. SCOTT R RAMMER
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Credential |
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Telephone | 920-994-4717
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 313M00000X
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Taxonomy Name | Nursing Facility/Intermediate Care Facility
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License Number | 0956
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License Number State | WI
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