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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