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Organization
SUNNY RIDGE
Active
Organization
SUNNY RIDGE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BARBARA JENTGES (OCCUPATIONAL THERAPIST)
(920) 453-7049
Entity
Organization
Contact information
Practice address
3014 ERIE AVE, SHEBOYGAN, WI 53081-3658
(920) 453-7049
Mailing address
3014 ERIE AVE, SHEBOYGAN, WI 53081-3658
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
1801968847
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2236-026
REGISTERED OT
WI
Enumeration date
05/22/2007
Last updated
07/18/2008
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