Provider Demographics
NPI:1376530626
Name:SAMARITAN HEALTH CENTER SUBACUTE UNIT
Entity Type:Organization
Organization Name:SAMARITAN HEALTH CENTER SUBACUTE UNIT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:CHANG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:262-334-8345
Mailing Address - Street 1:551 S SILVERBROOK DR
Mailing Address - Street 2:
Mailing Address - City:WEST BEND
Mailing Address - State:WI
Mailing Address - Zip Code:53095-3868
Mailing Address - Country:US
Mailing Address - Phone:262-334-8345
Mailing Address - Fax:
Practice Address - Street 1:551 S SILVERBROOK DR
Practice Address - Street 2:
Practice Address - City:WEST BEND
Practice Address - State:WI
Practice Address - Zip Code:53095-3868
Practice Address - Country:US
Practice Address - Phone:262-334-8345
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WIP270314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility