Organization
SAN LUIS MEDICAL & REHAB CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. SUSAN KAY RAASCH (PHYSICAL THERAPIST ASSISTANT)
(920) 494-5231
Entity
Organization
Contact information
Practice address
2305 SAN LUIS PL, GREEN BAY, WI 54304-5211
(920) 494-2855
Mailing address
2305 SAN LUIS PL, GREEN BAY, WI 54304-5211
(920) 494-2855
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
—
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
40165400
—
WI
Enumeration date
04/25/2008
Last updated
04/25/2008
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