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General NPI Number Information
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NPI Number | 1740010834
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Entity Type | Organization
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Legal Business Name | CHRISTIAN HOME CARE AND REHAB CENTER LLC
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Dates
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Enumeration Date | 08/05/2024
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Last Update Date | 08/05/2024
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Provider Practice Location Address
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Address Line | 452 FOX LAKE RD
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City | WAUPUN
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State | WI
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Zip | 53963-1761
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Country | US
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Telephone | 920-324-9051
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Fax |
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Provider Business Mailing Address
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Address Line | 452 FOX LAKE RD
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City | WAUPUN
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State | WI
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Zip | 53963-1761
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Country | US
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Telephone | 920-324-9051
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Fax |
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Authorized Official
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Title or Position | AUTHORIZED OFFICIAL
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Name | SHALOM STEIN
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Credential |
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Telephone | 732-313-0880
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number |
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License Number State |
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Taxonomy #3
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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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