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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