Provider Demographics
NPI:1386644672
Name:OAK RIDGE CARE CENTER, INC.
Entity Type:Organization
Organization Name:OAK RIDGE CARE CENTER, INC.
Other - Org Name:HOPE HEALTH AND REHABILITATION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:D
Authorized Official - Last Name:KURANZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-269-4386
Mailing Address - Street 1:PO BOX 280
Mailing Address - Street 2:438 ASHFORD AVE
Mailing Address - City:LOMIRA
Mailing Address - State:WI
Mailing Address - Zip Code:53048-0280
Mailing Address - Country:US
Mailing Address - Phone:920-269-4386
Mailing Address - Fax:920-269-4978
Practice Address - Street 1:438 ASHFORD AVE
Practice Address - Street 2:
Practice Address - City:LOMIRA
Practice Address - State:WI
Practice Address - Zip Code:53048-9578
Practice Address - Country:US
Practice Address - Phone:920-269-4386
Practice Address - Fax:920-269-4978
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3222314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI20179600Medicaid
WI20179600Medicaid