Organization
WISCONSIN ILLINOIS SENIOR HOUSING INC.
Active
Other names
Montello Care Center
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. STEPHANIE L SHERMAN (MEDICAL PROGRAM MONITOR)
(303) 980-0611
Entity
Organization
Contact information
Practice address
251 FOREST LN, MONTELLO, WI 53949-9380
(608) 297-2153
(608) 297-9328
Mailing address
251 FOREST LN, MONTELLO, WI 53949-9380
(608) 297-2153
(608) 297-9328
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
314000000X
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
20186200
—
WI
Enumeration date
07/11/2005
Last updated
05/13/2020
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