NPIMap

Organization Active NPI

Wisconsin Illinois Senior Housing, Inc.

  • Skilled Nursing Facility
  • Edgerton, WI
National Provider Identifier
1265593503
Registry record updated Jul 18, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
2235 Issued in WI
Legal business name
WISCONSIN ILLINOIS SENIOR HOUSING, INC.
Practice address
313 Stoughton Rd
Edgerton, WI 53534-1132
Phone
(608) 884-1330
Fax
(608) 884-1331
NPI assigned
Dec 12, 2006
Last updated
Jul 18, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 18, 2013

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Nicole Hayes, NHA
Title
Nursing Home Administrator
Phone
(608) 884-1617

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X 2235 WI Primary

Addresses

Primary practice location

313 Stoughton Rd
Edgerton, WI 53534-1132

Mailing address

313 Stoughton Rd
Edgerton, WI 53534-1132
Phone (608) 884-1330

Other identifiers 4

IdentifierTypeStateIssuer
568796OtherWIDEAN HEALTH PLAN
20198100MedicaidWI
390819992038OtherWIBLUE CROSS & BLUE SHIELD
20139400MedicaidWI

Other names 1

  • Edgerton Care Center Inc. Former legal business name

National Provider Directory

National Provider Directory
Tax ID family
Edgertonmilton Clinics13 organizations share this tax ID, including this one

Other organizations with this tax ID 12

Organizations that report the same tax identification number in the National Provider Directory.

Locations

313 Stoughton Rd
Edgerton, WI 53534
Phone (608) 884-1330

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1165881600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1374105600000",
    "number": "1265593503",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "313 STOUGHTON RD",
            "city": "EDGERTON",
            "state": "WI",
            "postal_code": "535341132",
            "telephone_number": "608-884-1330",
            "fax_number": "608-884-1331"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "313 STOUGHTON RD",
            "city": "EDGERTON",
            "state": "WI",
            "postal_code": "535341132",
            "telephone_number": "608-884-1330",
            "fax_number": "608-884-1331"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WISCONSIN ILLINOIS SENIOR HOUSING, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-12",
        "last_updated": "2013-07-18",
        "status": "A",
        "authorized_official_last_name": "HAYES",
        "authorized_official_first_name": "NICOLE",
        "authorized_official_title_or_position": "NURSING HOME ADMINISTRATOR",
        "authorized_official_telephone_number": "608-884-1617",
        "authorized_official_credential": "NHA"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "WI",
            "license": "2235",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DEAN HEALTH PLAN",
            "identifier": "568796",
            "state": "WI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "20198100",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS & BLUE SHIELD",
            "identifier": "390819992038",
            "state": "WI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "20139400",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Edgerton Care Center Inc.",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Edgerton, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 18, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.