Provider Demographics
NPI:1902460348
Name:BAY AT OCONTO HEALTH AND REHABILITATION CENTER LLC
Entity Type:Organization
Organization Name:BAY AT OCONTO HEALTH AND REHABILITATION CENTER LLC
Other - Org Name:OCONTO HEALTH AND REHABILITATION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MR
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 1:165 N VILLAGE AVE
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE CENTRE
Mailing Address - State:NY
Mailing Address - Zip Code:11570-3761
Mailing Address - Country:US
Mailing Address - Phone:516-605-9800
Mailing Address - Fax:
Practice Address - Street 1:101 1ST ST
Practice Address - Street 2:
Practice Address - City:OCONTO
Practice Address - State:WI
Practice Address - Zip Code:54153-1117
Practice Address - Country:US
Practice Address - Phone:516-605-9800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-30
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
WI41536700Medicaid