Provider Demographics
NPI:1003364639
Name:WAKEFIELD CARE AND REHABILITATION CENTER, LLC
Entity Type:Organization
Organization Name:WAKEFIELD CARE AND REHABILITATION CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHWARTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:201-635-1195
Mailing Address - Street 1:509 GROVE ST
Mailing Address - Street 2:
Mailing Address - City:WAKEFIELD
Mailing Address - State:KS
Mailing Address - Zip Code:67487-9159
Mailing Address - Country:US
Mailing Address - Phone:785-461-5417
Mailing Address - Fax:785-461-5667
Practice Address - Street 1:509 GROVE ST
Practice Address - Street 2:
Practice Address - City:WAKEFIELD
Practice Address - State:KS
Practice Address - Zip Code:67487-9159
Practice Address - Country:US
Practice Address - Phone:785-461-5417
Practice Address - Fax:785-461-5667
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-12
Last Update Date:2017-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA175272Medicare Oscar/Certification