Provider Demographics
NPI:1164806261
Name:TERRACE COURT SENIOR LIVING, INC.
Entity Type:Organization
Organization Name:TERRACE COURT SENIOR LIVING, INC.
Other - Org Name:MOUNTAIN TERRACE SENIOR LIVING CBRF
Other - Org Type:Doing Business As
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:LEE
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-401-1369
Mailing Address - Street 1:3402 TERRACE CT
Mailing Address - Street 2:
Mailing Address - City:WAUSAU
Mailing Address - State:WI
Mailing Address - Zip Code:54401-4914
Mailing Address - Country:US
Mailing Address - Phone:715-843-5230
Mailing Address - Fax:715-845-1768
Practice Address - Street 1:3402 TERRACE CT
Practice Address - Street 2:
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54401-4914
Practice Address - Country:US
Practice Address - Phone:715-843-5230
Practice Address - Fax:715-845-1768
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-17
Last Update Date:2020-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility