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General NPI Number Information
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NPI Number | 1689931321
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Entity Type | Organization
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Legal Business Name | KINDRED NURSING AND REHAB KENOSHA NORTH
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Dates
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Enumeration Date | 04/19/2012
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Last Update Date | 04/19/2012
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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 | 262-653-2941
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Fax |
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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 | 262-653-2941
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Fax |
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Authorized Official
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Title or Position | PROGRAM DIRECTOR
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Name | JERRY GRATZ
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Credential |
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Telephone | 262-653-2941
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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 | 1607-019
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License Number State | WI
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