Provider Demographics
NPI:1801340492
Name:SANCTUARY WSP OPERATIONS, LLC
Entity type:Organization
Organization Name:SANCTUARY WSP OPERATIONS, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JEROME
Authorized Official - Middle Name:E
Authorized Official - Last Name:FINIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-837-0704
Mailing Address - Street 1:333 W WACKER DR
Mailing Address - Street 2:SUITE 1010
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60606-1220
Mailing Address - Country:US
Mailing Address - Phone:312-837-0701
Mailing Address - Fax:312-837-0728
Practice Address - Street 1:1746 OAKDALE AVE
Practice Address - Street 2:
Practice Address - City:WEST ST PAUL
Practice Address - State:MN
Practice Address - Zip Code:55118-3504
Practice Address - Country:US
Practice Address - Phone:855-806-0533
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-11
Last Update Date:2016-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN37-7502310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility