Provider Demographics
NPI:1275130403
Name:APPLETON NURSING AND REHAB LLC
Entity Type:Organization
Organization Name:APPLETON NURSING AND REHAB LLC
Other - Org Name:MANOR CARE OF APPLETON
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ROSTISLAV
Authorized Official - Middle Name:
Authorized Official - Last Name:PUKSHANSKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-842-7575
Mailing Address - Street 1:8170 MCCORMICK BLVD STE 119
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60076-2961
Mailing Address - Country:US
Mailing Address - Phone:847-942-7575
Mailing Address - Fax:
Practice Address - Street 1:1335 S ONEIDA ST
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54915-1351
Practice Address - Country:US
Practice Address - Phone:920-731-6646
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-01
Last Update Date:2022-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility