Provider Demographics
NPI:1457806176
Name:HERITAGE RICE LAKE OPERATIONS LLC
Entity Type:Organization
Organization Name:HERITAGE RICE LAKE OPERATIONS LLC
Other - Org Name:HERITAGE MANOR OF RICE LAKE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER/MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:EPHRAM
Authorized Official - Middle Name:
Authorized Official - Last Name:LAHASKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:646-772-3668
Mailing Address - Street 1:34 LORD AVE
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:NY
Mailing Address - Zip Code:11559-1324
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:19 W NEWTON ST
Practice Address - Street 2:
Practice Address - City:RICE LAKE
Practice Address - State:WI
Practice Address - Zip Code:54868-1744
Practice Address - Country:US
Practice Address - Phone:715-234-2161
Practice Address - Fax:715-234-1705
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-23
Last Update Date:2016-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility