Healthcare Provider Details

I. General information

NPI: 1366365876
Provider Name (Legal Business Name): WISCONSIN MASONIC HOME INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2026
Last Update Date: 08/01/2026
Certification Date: 08/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

365 SUNSET DR
DOUSMAN WI
53118-8842
US

IV. Provider business mailing address

240 MASON WAY
DOUSMAN WI
53118-8868
US

V. Phone/Fax

Practice location:
  • Phone: 262-965-7214
  • Fax: 262-965-7035
Mailing address:
  • Phone: 262-965-7214
  • Fax: 262-965-7035

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: MELISSA CURRAN
Title or Position: CFO
Credential: CFO
Phone: 262-965-7203