Organization
CRYSTAL FOUNTAINS REHABILITATION CENTER LLC
Active
Other names
Santa Maria Nursing Home
Organization subpart
No
Provider details
NPI number
Authorized official
KAREN TRZEBIATOWSKI RN (DIRECTOR OF OPERATIONS)
(715) 340-1479
Entity
Organization
Contact information
Practice address
403 SOUTH CLAY ST, GREEN BAY, WI 54301-3807
(920) 432-5231
(920) 432-9881
Mailing address
3450 BRIDLEWOOD DR, PLOVER, WI 54467-3892
(715) 342-9100
(715) 342-9101
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
1134
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
20152400
—
WI
Enumeration date
12/21/2015
Last updated
12/21/2015
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