Provider Demographics
NPI:1427266550
Name:SUNNY RIDGE HEALTH AND REHAB
Entity type:Organization
Organization Name:SUNNY RIDGE HEALTH AND REHAB
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGIONAL DIRECTOR OF THERAPY
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:M
Authorized Official - Last Name:KASTENHOLZ
Authorized Official - Suffix:
Authorized Official - Credentials:OTR
Authorized Official - Phone:612-747-0119
Mailing Address - Street 1:2644 N 71ST ST
Mailing Address - Street 2:
Mailing Address - City:WAUWATOSA
Mailing Address - State:WI
Mailing Address - Zip Code:53213-1349
Mailing Address - Country:US
Mailing Address - Phone:612-747-0119
Mailing Address - Fax:
Practice Address - Street 1:3014 ERIE AVE
Practice Address - Street 2:
Practice Address - City:SHEBOYGAN
Practice Address - State:WI
Practice Address - Zip Code:53081-3658
Practice Address - Country:US
Practice Address - Phone:920-459-3028
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3086-026313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility