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Organization
PINE HAVEN CHRISTIAN HOME INC
Active
Organization
PINE HAVEN CHRISTIAN HOME INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARTIN HALVERSON (CFO)
(920) 550-5257
Entity
Organization
Contact information
Practice address
220 HAVEN DRIVE, SHEBOYGAN FALLS, WI 53085
(920) 467-2401
(920) 467-7273
Mailing address
531 GIDDINGS AVE, PINE HAVEN CHRISTIAN HOME INC, SHEBOYGAN FALLS, WI 53085-1707
(920) 467-2401
(920) 467-7273
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
356
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
20012000
—
WI
Enumeration date
09/02/2005
Last updated
06/22/2015
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