North Oak Health Care Wisteria Haus LLC

Primary specialty

Nursing Facility/Intermediate Care FacilityTaxonomy code 313M00000X

License

0016823 Issued in WI

Legal business name

NORTH OAK HEALTH CARE WISTERIA HAUS LLC

Doing business as

Wisteria Haus

Practice address

2741 45TH St
Two Rivers, WI 54241-1002

Phone

(847) 612-0750

Fax

(920) 794-4057

NPI assigned

Sep 26, 2017

Last updated

Aug 14, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Dean Carl Maschoff

Title

Member

Phone

(847) 612-0750

Specialties & licenses 2

Addresses

Other names 1

• Wisteria Haus Doing business as

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

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

{
    "created_epoch": "1506384000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1597363200000",
    "number": "1417466152",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1025 SHERMER RD",
            "city": "NORTHBROOK",
            "state": "IL",
            "postal_code": "600623730"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2741 45TH ST",
            "city": "TWO RIVERS",
            "state": "WI",
            "postal_code": "542411002",
            "telephone_number": "847-612-0750",
            "fax_number": "920-794-4057"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTH OAK HEALTH CARE WISTERIA HAUS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-09-26",
        "last_updated": "2020-08-14",
        "certification_date": "2020-08-14",
        "status": "A",
        "authorized_official_last_name": "MASCHOFF",
        "authorized_official_first_name": "DEAN",
        "authorized_official_middle_name": "CARL",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "847-612-0750",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "313M00000X",
            "taxonomy_group": "",
            "desc": "Nursing Facility/Intermediate Care Facility",
            "state": "WI",
            "license": "0016823",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Wisteria Haus",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Marvin Robert Moore, PHARM.D.
• Jeffrey S. Nesta, MD
• Paul Steven Neuenfeldt, LAT, ATC
• Rae Nigh, DPT
• Mackenzie Nigl, RPH, PHARM.D.
• Karen Ann Novy, OTR
• NSH Two Rivers LLC (Hamilton Health Services)
• Breanna M O'Neil, MD
• Mark R Oleck, CRNA
• Shilea Kaye Olson

• Nursing Facility/Intermediate Care Facility in Two Rivers, WI
• Providers in Two Rivers, WI by specialty
• Nursing Facility/Intermediate Care Facility in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 14, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.