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NPI Code Detail

MEDICARE: S-H OPCO WILSON MOUNTAIN, LLC

MEDICARE: S-H OPCO WILSON MOUNTAIN, LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1310400000XAssisted Living Facility

General Provider Information

NPI Number : 1548678675
Entity Type Code : Organization
Provider Name (Legal Business Name) : S-H OPCO WILSON MOUNTAIN, LLC
Provider Business Mailing Address
First Line : 6737 W WASHINGTON ST
Second Line : SUITE 2300
City : MILWAUKEE
State : WI
Zip : 53214-5647
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 391 COMMON ST
Second Line :
City : DEDHAM
State : MA
Zip : 02026-4055
Country : US
Telephone Number : 781-407-7711
Fax Number :
Authorized Official
Title or Position : CFO
Name : MARK OHLENDORF
Credential :
Telephone Number : 414-918-5000
Provider Enumeration Date : 08/01/2014
Last Update Date : 08/01/2014

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Directions to “S-H OPCO WILSON MOUNTAIN, LLC ” Practice Location

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