Organization
EHF WAUSAU SNF OP, LLC
Active
Other names
Wausau Manor
Organization subpart
No
Provider details
NPI number
Authorized official
DONNA JO MAASSEN (DIRECTOR OF COMPLIANCE)
(414) 908-8119
Entity
Organization
Contact information
Practice address
3107 WESTHILL DR, WAUSAU, WI 54401-3774
(715) 842-0575
(715) 842-0577
Mailing address
111 W MICHIGAN ST, MILWAUKEE, WI 53203-2903
(414) 908-8119
(414) 908-7105
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
2890
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1267430001
MEDICARE DMEPOS
—
05
—
20199400
—
WI
Enumeration date
07/28/2005
Last updated
02/11/2008
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