| NPI | 1417466152 |
|---|---|
| Doing Business As | WISTERIA HAUS |
| Entity Type | Organization |
| Authorized Contact | DEAN CARL MASCHOFF Member 847-612-0750 |
| Organization Subpart ? | No |
| Primary Taxonomy | 313M00000X Nursing Facility/Intermediate Care Facility (Licence: WI 0016823) |
| Additional Taxonomies | 310400000X Assisted Living Facility |
| Enumeration Date | 2017-09-26 |
| Last Update Date | 2020-08-14 |