| NPI | 1164072898 |
|---|---|
| Doing Business As | MEADOWBROOK AT BLACK RIVER FALLS |
| Entity Type | Organization |
| Authorized Contact | ROSTISLAV PUKSHANSKY Partner 847-942-7575 |
| Organization Subpart ? | No |
| Primary Taxonomy | 314000000X Skilled Nursing Facility |
| Enumeration Date | 2019-09-15 |
| Last Update Date | 2022-02-03 |