Organization
LARSON HOUSE PLATINUM LLC
Active
Other names
Larson House South, Larson House
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN TERESINSKI (MANAGING DIRECTOR)
(414) 940-6608
Entity
Organization
Contact information
Practice address
550 RIVER RD, COLUMBUS, WI 53925-1721
(920) 623-5253
(920) 623-5255
Mailing address
2448 S 102ND ST STE 305, WEST ALLIS, WI 53227-2141
(414) 940-6608
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0015679
WISCONSIN DHS
WI
01
—
0016818
WISCNSIN DHS
WI
Enumeration date
04/22/2020
Last updated
04/22/2020
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