# SAN LUIS MEDICAL & REHAB CENTER

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1588839492
- **Authorized official:** MRS. LAURA ANN KNUDSEN (PHYSICAL THERAPIST ASSISTANT)
- **Authorized official phone:** (920) 494-5231

## Contact information

- **Practice address:** 2305 SAN LUIS PL, GREEN BAY, WI 54304-5211
- **Practice address phone:** (920) 494-5231
- **Practice address fax:** (920) 494-2855
- **Mailing address:** 2305 SAN LUIS PL, GREEN BAY, WI 54304-5211
- **Mailing address phone:** (920) 494-5231
- **Mailing address fax:** (920) 494-2855

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | — | NULL | Yes |

## Other

- **Enumeration date:** 04/23/2008
- **Last updated:** 04/23/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 40275000 | — | WI |