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Organization
WISCONSIN ILLINOIS SENIOR HOUSING, INC.
Active
Organization
WISCONSIN ILLINOIS SENIOR HOUSING, INC.
Active
Other names
Edgerton Care Center Inc.
Organization subpart
No
Provider details
NPI number
Authorized official
NICOLE HAYES NHA (NURSING HOME ADMINISTRATOR)
(608) 884-1617
Entity
Organization
Contact information
Practice address
313 STOUGHTON RD, EDGERTON, WI 53534-1132
(608) 884-1330
(608) 884-1331
Mailing address
313 STOUGHTON RD, EDGERTON, WI 53534-1132
(608) 884-1330
(608) 884-1331
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
2235
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
20139400
—
WI
05
—
20198100
—
WI
01
—
390819992038
BLUE CROSS & BLUE SHIELD
WI
01
—
568796
DEAN HEALTH PLAN
WI
Enumeration date
12/12/2006
Last updated
07/18/2013
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