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NPI Code Detail

MEDICARE: WISCONSIN ILLINOIS SENIOR HOUSING INC.

MEDICARE: WISCONSIN ILLINOIS SENIOR HOUSING INC.
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 Facility0076WI
2314000000XSkilled Nursing Facility2287WI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1659371938
Entity Type Code : Organization
Provider Name (Legal Business Name) : WISCONSIN ILLINOIS SENIOR HOUSING INC.
Provider Business Mailing Address
First Line : 407 N 8TH ST
Second Line :
City : MOUNT HOREB
State : WI
Zip : 53572-1872
Country : US
Telephone Number : 608-437-5511
Fax Number : 608-437-9603
Provider Business Practice Location Address
First Line : 407 N 8TH ST
Second Line :
City : MOUNT HOREB
State : WI
Zip : 53572-1872
Country : US
Telephone Number : 608-437-5511
Fax Number : 608-437-9603
Authorized Official
Title or Position : CHIEF OPERATING OFFICER
Name : STEPHANIE SHERMAN
Credential :
Telephone Number : 303-980-0611
Provider Enumeration Date : 07/28/2005
Last Update Date : 05/13/2020

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