Organization
WISCONSIN ILLINOIS SENIOR HOUSING INC.
Active
Other names
Fair Oaks Health Care Center
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
471 W TERRA COTTA AVE, CRYSTAL LAKE, IL 60014-3434
(815) 455-0550
(815) 356-3846
Mailing address
471 W TERRA COTTA AVE, CRYSTAL LAKE, IL 60014-3434
(815) 455-0550
(815) 356-3846
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
0040915
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6002976
—
IL
Enumeration date
10/19/2005
Last updated
05/13/2020
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