Organization
WISCONSIN ILLINOIS SENIOR HOUSING INC.
Active
Other names
HOLTON 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
645 N. CHURCH ST, ELKHORN, WI 53121
(262) 723-4963
(262) 723-8982
Mailing address
645 N. CHURCH ST, ELKHORN, WI 53121
(262) 723-4963
(262) 723-8982
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
2665
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
20184300
—
WI
Enumeration date
08/18/2005
Last updated
05/13/2020
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