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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