Provider Demographics
NPI:1629504352
Name:THE BAY AT SHERIDAN HEALTH AND REHABILITATION LLC
Entity Type:Organization
Organization Name:THE BAY AT SHERIDAN HEALTH AND REHABILITATION LLC
Other - Org Name:SHERIDAN HEALTH AND REHABILITATION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MENACHEM
Authorized Official - Middle Name:
Authorized Official - Last Name:RUVEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-605-9800
Mailing Address - Street 1:8400 SHERIDAN RD
Mailing Address - Street 2:
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53143-6327
Mailing Address - Country:US
Mailing Address - Phone:262-658-4141
Mailing Address - Fax:
Practice Address - Street 1:8400 SHERIDAN RD
Practice Address - Street 2:
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53143
Practice Address - Country:US
Practice Address - Phone:262-658-4141
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-01
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
525318Medicare Oscar/Certification