Organization
SHEBOYGAN SENIOR COMMUNITY
Active
Other names
Kindred
Organization subpart
No
Provider details
NPI number
Authorized official
AMY VAN RUDEN OTR (REGINAL MANAGER)
(242) 939-5296
Entity
Organization
Contact information
Practice address
1702 29TH ST, TWO RIVERS, WI 54241-2010
(920) 242-4727
Mailing address
1702 29TH ST, TWO RIVERS, WI 54241-2010
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
1575-19
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
526538
—
WI
Enumeration date
04/15/2013
Last updated
04/15/2013
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