Provider Demographics
NPI:1861661308
Name:CEDAR SPRINGS HEALTH & REHADILITATION CENTER
Entity Type:Organization
Organization Name:CEDAR SPRINGS HEALTH & REHADILITATION CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OCCUPATIONAL THERAPIST REGISTERED
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBBIE
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:DLUGOPOLSKI
Authorized Official - Suffix:
Authorized Official - Credentials:OTR
Authorized Official - Phone:262-376-7676
Mailing Address - Street 1:N27W5707 LINCOLN BLVD
Mailing Address - Street 2:
Mailing Address - City:CEDARBURG
Mailing Address - State:WI
Mailing Address - Zip Code:53012-2852
Mailing Address - Country:US
Mailing Address - Phone:262-376-7676
Mailing Address - Fax:262-376-5208
Practice Address - Street 1:961 LAMPLIGHTER LN
Practice Address - Street 2:
Practice Address - City:GRAFTON
Practice Address - State:WI
Practice Address - Zip Code:53024-9314
Practice Address - Country:US
Practice Address - Phone:262-387-0023
Practice Address - Fax:262-387-0025
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-28
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY2103-026313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40740900Medicaid