Provider Demographics
NPI:1861796492
Name:FAMILY HERITAGE NURSING & REHABILITATION CENTER LLC
Entity type:Organization
Organization Name:FAMILY HERITAGE NURSING & REHABILITATION CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:MOSHE
Authorized Official - Middle Name:
Authorized Official - Last Name:ORLINSKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-588-7518
Mailing Address - Street 1:1311 TYLER ST
Mailing Address - Street 2:
Mailing Address - City:BLACK RIVER FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:54615-1564
Mailing Address - Country:US
Mailing Address - Phone:715-284-4396
Mailing Address - Fax:715-284-7786
Practice Address - Street 1:1311 TYLER ST
Practice Address - Street 2:
Practice Address - City:BLACK RIVER FALLS
Practice Address - State:WI
Practice Address - Zip Code:54615-1564
Practice Address - Country:US
Practice Address - Phone:715-284-4396
Practice Address - Fax:715-284-7786
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-22
Last Update Date:2011-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3211314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI20183900Medicaid
WI100012961Medicaid
WI525488Medicare Oscar/Certification