Organization
FOND DU LAC NURSING AND REHAB, LLC
Active
Other names
Edenbrook of Fond du Lac
Organization subpart
No
Provider details
NPI number
Authorized official
PAMELA RICE (DIRECTOR OF REVENUE)
(773) 825-3336
Entity
Organization
Contact information
Practice address
265 S NATIONAL AVE, FOND DU LAC, WI 54935-5334
(920) 922-7342
Mailing address
8170 MCCORMICK BLVD STE 112, SKOKIE, IL 60076-2914
(773) 825-3336
(773) 570-4554
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
—
—
Other
Enumeration date
09/27/2018
Last updated
09/16/2020
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