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Organization
WISCONSIN ILLINOIS SENIOR HOUSING INC.
Active
Organization
WISCONSIN ILLINOIS SENIOR HOUSING INC.
Active
Other names
Wild Rose Manor
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. STEPHANIE L. SHERMAN (MEDICARE PROGRAM MONITOR)
(303) 980-0611
Entity
Organization
Contact information
Practice address
425 SUMMIT ST, WILD ROSE, WI 54984-6804
(920) 622-4342
(920) 622-3655
Mailing address
425 SUMMIT ST, WILD ROSE, WI 54984-6804
(920) 622-4342
(920) 622-3655
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
2606
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
20184100
—
WI
Enumeration date
09/07/2005
Last updated
05/13/2020
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