COUNTY OF WOOD (NPI# 1013915339) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1013915339 |
| Entity Type | Organization |
| Organization Name | COUNTY OF WOOD |
| Other Organization Name | EDGEWATER HAVEN NURSING HOME |
| Practice Address |
1351 Wisconsin River Dr Port Edwards WI 54469-1041 |
| Mailing Address |
1351 Wisconsin River Dr Port Edwards WI 54469-1099 |
| Practice Telephone | 7158858300 |
| Practice Fax Number | 7158858351 |
| Mailing Telephone | 7158858300 |
| Mailing Fax Number | 7158858351 |
| Enumeration Date | 2005-07-11 |
| Last Update Date | 2011-11-03 |
| Authorized Official Name | MS. AMY M SLATTERY (ADMINISTRATOR) |
| Authorized Official Telephone | 7158858324 |
| Authorized Official Credential | NHA |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 314000000X | Skilled Nursing Facility | 2369 | WI | Nursing & Custodial Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WI | 20131100 | 05 |
| Other Name | Type Code |
|---|---|
| Edgewater Haven Nursing Home | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457334922 | County of Wood | Skilled Nursing Facility | 1600 N Chestnut Ave, Marshfield, WI 54449-1449 | 2005-11-29 |
| 1063638088 | County of Wood | Counselor | 2611 12th St S, Wisconsin Rapids, WI 54494-6445 | 2007-04-18 |
| 1508840844 | County of Wood | Psychiatric Hospital | 1600 N Chestnut Ave, Marshfield, WI 54449-1449 | 2005-11-30 |
| 1639153976 | County of Wood | Intermediate Care Facility, Mentally Retarded | 1600 N Chestnut Ave, Marshfield, WI 54449-1449 | 2005-11-30 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | COUNTY OF WOODFORD | 109 W Cruger Ave, Eureka, IL 61530-1345 |
| Street Address |
1351 WISCONSIN RIVER DR |
| City | PORT EDWARDS |
| State | WI |
| Zip Code | 54469-1041 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1376141473 | Sidrah Amhed Khan | Speech-Language Pathologist | 1351 Wisconsin River Dr, Port Edwards, WI 54469-1099 | 2020-10-12 |
| 1790103554 | Amanda Sue Veriha | Physical Therapy Assistant | 1351 Wisconsin River Dr, Port Edwards, WI 54469-1041 | 2014-03-30 |
| 1609033372 | Lisa Lynn O'shasky | Occupational Therapy Assistant | 1351 Wisconsin River Dr, Port Edwards, WI 54469-1041 | 2008-05-20 |
| 1699955286 | Michael Lynn Bernarde | Physical Therapy Assistant | 1351 Wisconsin River Dr, Port Edwards, WI 54469-1041 | 2007-11-12 |
| 1649450222 | Sharon K. Holy | Physical Therapist | 1351 Wisconsin River Dr, Port Edwards, WI 54469-1041 | 2007-11-12 |
| 1548440142 | Dianna Witt | Occupational Therapy Assistant | 1351 Wisconsin River Dr, Port Edwards, WI 54469-1041 | 2007-11-12 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1790853786 | Lisa M Machotka | Physical Therapist | 661 Westport Ct, Port Edwards, WI 54469-1176 | 2006-11-30 |
| 1982864468 | Karen Schaub Stewart | Registered Nurse | 741 5th St, Port Edwards, WI 54469-1213 | 2008-06-10 |
| 1104010610 | Port Edwards School District | Local Education Agency (LEA) | 801 2nd St, Port Edwards, WI 54469-1301 | 2007-08-29 |
| 1609128263 | Connor Andrew Tiggerus | Counselor | 131 Washington Ave, Port Edwards, WI 54469-1313 | 2012-10-08 |
| 1740274422 | John G Cronkrite | Dentist | 211 Market Ave, Port Edwards, WI 54469-1347 | 2005-09-08 |
| 1669923249 | John E Alexander South Wood County Young Men's Christian Association | Health Educator | 211 Wisconsin River Dr, Port Edwards, WI 54469-1437 | 2016-10-19 |
| Taxonomy Code | 314000000X |
| Grouping | Nursing & Custodial Care Facilities |
| Classification | Skilled Nursing Facility |
| (1) A skilled nursing facility is a facility or distinct part of an institution whose primary function is to provide medical, continuous nursing, and other health and social services to patients who are not in an acute phase of illness requiring services in a hospital, but who require primary restorative or skilled nursing services on an inpatient basis above the level of intermediate or custodial care in order to reach a degree of body functioning to permit self care in essential daily living. It meets any licensing or certification standards et forth by the jurisdiction where it is located. A skilled nursing facility may be a freestanding facility or part of a hospital that has been certified by Medicare to admit patients requiring subacute care and rehabilitation; (2) Provides non-acute medical and skilled nursing care services, therapy and social services under the supervision of a licensed registered nurse on a 24-hour basis. |
| Notes: Source: (1) "Glossary of terms used in managed care" Developed by the Managed Care Assembly (MCA) of Medical Group Management Association (MGMA), MGM Journal, September/October 1995, p. 64; (2) AHA Guide, 1996 Annual Survey. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356962369 | Heritage Assisted Living, LLC | Skilled Nursing Facility | 5020 S 107th St, Greenfield, WI 53228-3267 | 2020-04-30 |
| 1235762881 | Imr Oak Creek Opco, LLC | Skilled Nursing Facility | 2700 West Honadel Boulevard, Oak Creek, WI 53154 | 2020-02-21 |
| 1831693936 | Golden Years Nursing Home, Inc. | Skilled Nursing Facility | 611 Harmony Dr, Lake Geneva, WI 53147-8800 | 2018-03-22 |
| 1801302732 | Oak Park Place of Janesville, LLC | Skilled Nursing Facility | 700 Myrtle Way, Janesville, WI 53545-9101 | 2017-12-14 |
| 1235674839 | Zachary Rader | Skilled Nursing Facility | 645 N Church St, Elkhorn, WI 53121-2204 | 2017-01-05 |
| 1982155248 | The Bethany-st. Joseph Corporation D/b/a Prairie Pointe Rehab Suites | Skilled Nursing Facility | 286 N. Willson Dr, Altoona, WI 54720 | 2016-10-20 |
| 1316492317 | Darcy Christiansen | Skilled Nursing Facility | 4427 E Pic A Dilly Dr, Janesville, WI 53546-9606 | 2016-08-19 |
| 1366895583 | Jeffrey Alan Weinshrott | Skilled Nursing Facility | 336 Wisconsin Ave, Sheboygan, WI 53081-4183 | 2016-07-22 |
| 1720433378 | Kendra Meyers | Skilled Nursing Facility | 1806 N Hume Ave Apt 4, Marshfield, WI 54449-1677 | 2016-05-02 |
| 1952756991 | Grace Lutheran Foundation Inc | Skilled Nursing Facility | 206 North Willson Drive, Altoona, WI 54720 | 2016-04-27 |
| Find all providers with the same taxonomy | ||||
| City | PORT EDWARDS |
| Zip Code | 54469 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.