Organization
LAKESHORE MANOR MEMORY CARE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANYA VISTMAN (CORP COUNSEL)
(773) 819-2190
Entity
Organization
Contact information
Practice address
711 BAY SHORE DR, OSHKOSH, WI 54901-5218
(920) 393-3871
Mailing address
8170 MCCORMICK BLVD STE 112, SKOKIE, IL 60076-2914
(773) 819-2190
Taxonomy
Speciality
Code
Description
License number
State
376G00000X
Nursing Home Administrator
Primary
—
—
Other
Enumeration date
03/14/2021
Last updated
03/14/2021
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