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Organization
WISCONSIN ILLINOIS SENIOR HOUSING INC.
Active
Organization
WISCONSIN ILLINOIS SENIOR HOUSING INC.
Active
Other names
Ingleside Manor
Organization subpart
No
Provider details
NPI number
Authorized official
STEPHANIE SHERMAN (CHIEF OPERATING OFFICER)
(303) 980-0611
Entity
Organization
Contact information
Practice address
407 N 8TH ST, MOUNT HOREB, WI 53572-1872
(608) 437-5511
(608) 437-9603
Mailing address
407 N 8TH ST, MOUNT HOREB, WI 53572-1872
(608) 437-5511
(608) 437-9603
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
0076
WI
314000000X
Skilled Nursing Facility
Primary
2287
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1518213222
—
WI
Enumeration date
07/28/2005
Last updated
05/13/2020
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