MEDICARE: CHRISTIAN HOME CARE AND REHAB CENTER LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	310400000X	Assisted Living Facility
2	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
3	314000000X	Skilled Nursing Facility

General Provider Information

NPI Number	:	1740010834
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CHRISTIAN HOME CARE AND REHAB CENTER LLC

Provider Business Mailing Address
First Line	:	452 FOX LAKE RD
Second Line	:
City	:	WAUPUN
State	:	WI
Zip	:	53963-1761
Country	:	US
Telephone Number	:	920-324-9051
Fax Number	:

Provider Business Practice Location Address
First Line	:	452 FOX LAKE RD
Second Line	:
City	:	WAUPUN
State	:	WI
Zip	:	53963-1761
Country	:	US
Telephone Number	:	920-324-9051
Fax Number	:

Authorized Official
Title or Position	:	AUTHORIZED OFFICIAL
Name	:	SHALOM STEIN
Credential	:
Telephone Number	:	732-313-0880

Provider Enumeration Date	:	08/05/2024
Last Update Date	:	05/01/2026

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