Organization
PH KENOSHA LLC
Active
Other names
Kenosha Estates Living and Care Center
Organization subpart
No
Provider details
NPI number
Authorized official
BENJAMIN KLEIN (MEMBER)
(847) 329-4100
Entity
Organization
Contact information
Practice address
1703 60TH ST, KENOSHA, WI 53140-3986
(262) 658-4125
Mailing address
7444 LONG AVE, SKOKIE, IL 60077-3214
(847) 329-4100
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
—
—
Other
Enumeration date
02/11/2011
Last updated
02/11/2011
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