# WISCONSIN ILLINOIS SENIOR HOUSING INC.

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- **Entity:** Organization
- **Status:** Active
- **Other names:** HOLTON MANOR
- **Organization subpart:** No

## Provider details

- **NPI number:** 1134111826
- **Authorized official:** MRS. STEPHANIE L. SHERMAN (MEDICARE PROGRAM MONITOR)
- **Authorized official phone:** (303) 980-0611

## Contact information

- **Practice address:** 645 N. CHURCH ST, ELKHORN, WI 53121
- **Practice address phone:** (262) 723-4963
- **Practice address fax:** (262) 723-8982
- **Mailing address:** 645 N. CHURCH ST, ELKHORN, WI 53121
- **Mailing address phone:** (262) 723-4963
- **Mailing address fax:** (262) 723-8982

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | 2665 | WI | Yes |

## Other

- **Enumeration date:** 08/18/2005
- **Last updated:** 05/13/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 20184300 | — | WI |