Provider Demographics
NPI:1568686129
Name:BEECHWOOD REST HOME
Entity Type:Organization
Organization Name:BEECHWOOD REST HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NHA
Authorized Official - Prefix:MR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:R
Authorized Official - Last Name:RAMMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-994-4717
Mailing Address - Street 1:N1495W HIGHWAY A
Mailing Address - Street 2:
Mailing Address - City:KEWASKUM
Mailing Address - State:WI
Mailing Address - Zip Code:53040-9205
Mailing Address - Country:US
Mailing Address - Phone:920-994-4717
Mailing Address - Fax:920-994-4932
Practice Address - Street 1:N1495W HIGHWAY A
Practice Address - Street 2:
Practice Address - City:KEWASKUM
Practice Address - State:WI
Practice Address - Zip Code:53040-9205
Practice Address - Country:US
Practice Address - Phone:920-994-4717
Practice Address - Fax:920-994-4932
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI0956313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI20008600Medicaid