Provider Demographics
NPI:1598377905
Name:NOHC JACKSON SENIOR LIVING LLC
Entity Type:Organization
Organization Name:NOHC JACKSON SENIOR LIVING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:DEAN
Authorized Official - Middle Name:CARL
Authorized Official - Last Name:MASCHOFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-612-0750
Mailing Address - Street 1:1025 SHERMER RD
Mailing Address - Street 2:
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062-3730
Mailing Address - Country:US
Mailing Address - Phone:847-612-0750
Mailing Address - Fax:
Practice Address - Street 1:N16744 EAGLE DRIVE
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:WI
Practice Address - Zip Code:53037
Practice Address - Country:US
Practice Address - Phone:847-612-0750
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-18
Last Update Date:2020-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility