WISTERIA HAUS
NPI 1417466152
Nursing Facility/Intermediate Care Facility in Two Rivers, WI
- Organization
- Nursing Facility/Intermediate Care Facil...
- CLIA Number: 52D0964184
- CLIA Cert. Type: Assisted Living Facility
- CLIA Exp. Date: 08-18-2027
About WISTERIA HAUS
This page provides the complete NPI Profile along with additional information for Wisteria Haus, a provider established in Two Rivers, Wisconsin operating as a Nursing Facility/intermediate Care Facility. The healthcare provider is registered in the NPI registry with number 1417466152 assigned on September 2017. The practitioner's primary taxonomy code is 313M00000X with license number 0016823 (WI). The provider is registered as an organization and their NPI record was last updated 6 years ago. The provider's is doing business as Wisteria Haus. The authorized official of this NPI record is Mr. Dean Carl Maschoff (Member)
- NPI
- 1417466152 Verify this NPI
- Provider Legal Name
- NORTH OAK HEALTH CARE WISTERIA HAUS LLC
- Other Organization Name
- WISTERIA HAUS
- Other Name Type
- Doing Business As (3)
- Entity Type
- Organization
- Location Address
- 2741 45TH ST TWO RIVERS, WI 54241
- Location Phone
- (847) 612-0750
- Location Fax
- (920) 794-4057
- Mailing Address
- 1025 SHERMER RD NORTHBROOK, IL 60062
- Is Sole Proprietor?
- No
- Is Organization Subpart?
- No
- Enumeration Date
- 09-26-2017
- Last Update Date
- 08-14-2020
- Code Navigator
Location Map
Specialty - Primary Taxonomy
The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
- Classification
Nursing Facility/Intermediate Care Facility
- Taxonomy Code
- 313M00000X
- Type
- Nursing & Custodial Care Facilities
- License No.
- 0016823
- License State
- WI
- Taxonomy Description
- An institution (or a distinct part of an institution) which- (1) is primarily engaged in providing to residents- (A) skilled nursing care and related services for residents who require medical or nursing care, (B) rehabilitation services for the rehabilitation of injured, disabled, or sick persons, or, on a regular basis, health-related care and services to individuals who because of their mental or physical condition require care and services (above the level of room and board) which can be made available to them only through institutional facilities, and is not primarily for the care and treatment of mental diseases; (2) has in effect a transfer agreement with one or more hospitals.
Secondary Taxonomies
The provider has reported to the NPI enumerator additional taxonomy codes. Multiple taxonomy codes may represent subspecialties or other areas of specialization the provider maybe licensed to practice.
| No. | Taxonomy Code | Type | Classification / Specialization |
License No. (State) |
|---|---|---|---|---|
| 1 | 310400000X | Nursing & Custodial Care Facilities | Assisted Living Facility |
CLIA Information
The Clinical Laboratory Improvement Amendments (CLIA) of 1988 applies to facilities or sites that test human specimens for health assessment or to diagnose, prevent, or treat disease. The CLIA Program sets standards for clinical laboratory testing and issues certificates. The NPI / CLIA crosswalk information for this NPI number is:
- CLIA Number
- 52D0964184
- Facility Type
- Assisted Living Facility
- Certificate Effective Date
- August 19, 2025
- Certificate Expiration Date
- August 18, 2027
- Laboratory Director
- DOLORES MANTIK
- Certificate Type
- Certificate of Waiver
- Certificate Type Description
- This CLIA certificate is issued to Wisteria Haus to perform only waived tests. CLIA defines waived tests as simple tests with a low risk for an incorrect result. Waived tests include certain tests listed in CLIA regulations, tests cleared by the FDA for home use and tests approved by the FDA for waived status and that meet CLIA waiver criteria.
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Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1417466152, enumerated as an "organization" on September 26, 2017.
The provider is located at 2741 45TH ST TWO RIVERS, WI 54241 and the phone number is (847) 612-0750.
Nursing Facility/Intermediate Care Facility with taxonomy code 313M00000X.
