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Organization
CRYSTAL FOUNTAINS REHABILITATION CENTER LLC
Active
Organization
CRYSTAL FOUNTAINS REHABILITATION CENTER LLC
Active
Other names
Santa Maria Nursing Home
Organization subpart
No
Provider details
NPI number
Authorized official
KAREN TRZEBIATOWSKI RN (DIRECTOR OF OPERATIONS)
(715) 340-1479
Entity
Organization
Contact information
Practice address
403 SOUTH CLAY ST, GREEN BAY, WI 54301-3807
(920) 432-5231
(920) 432-9881
Mailing address
3450 BRIDLEWOOD DR, PLOVER, WI 54467-3892
(715) 342-9100
(715) 342-9101
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
1134
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
20152400
—
WI
Enumeration date
12/21/2015
Last updated
12/21/2015
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