Provider Demographics
NPI:1922618768
Name:RICE LAKE REHABILITATION AND CARE CENTER LLC
Entity Type:Organization
Organization Name:RICE LAKE REHABILITATION AND CARE CENTER LLC
Other - Org Name:HERITAGE LAKESIDE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MARKOWITZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-784-7709
Mailing Address - Street 1:1016 LAKESHORE DR
Mailing Address - Street 2:
Mailing Address - City:RICE LAKE
Mailing Address - State:WI
Mailing Address - Zip Code:54868-1225
Mailing Address - Country:US
Mailing Address - Phone:715-234-9101
Mailing Address - Fax:715-234-4021
Practice Address - Street 1:1016 LAKESHORE DR
Practice Address - Street 2:
Practice Address - City:RICE LAKE
Practice Address - State:WI
Practice Address - Zip Code:54868-1225
Practice Address - Country:US
Practice Address - Phone:715-234-9101
Practice Address - Fax:715-234-4021
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-06
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility