STATE OF WISCONSIN (NPI# 1043326747) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1043326747 |
| Entity Type | Organization |
| Organization Name | STATE OF WISCONSIN |
| Other Organization Name | SOUTHERN WISCONSIN CENTER |
| Practice Address |
21425 Spring St Union Grove WI 53182-9707 |
| Practice Telephone | 2628782411 |
| Practice Fax Number | 2628782922 |
| Mailing Telephone | 2628782411 |
| Mailing Fax Number | 2628782922 |
| Enumeration Date | 2006-08-22 |
| Last Update Date | 2008-02-14 |
| Authorized Official Name | MR. JAMES E HUTCHISON (NURSING HOME ADMINISTRATOR) |
| Authorized Official Telephone | 2628782411 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 315P00000X | Intermediate Care Facility, Mentally Retarded | 2763 | WI | Nursing & Custodial Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WI | 21050000 | 05 |
| Other Name | Type Code |
|---|---|
| Southern Wisconsin Center | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1558615815 | State of Wisconsin | Skilled Nursing Facility | 2175 E Park Ave, Chippewa Falls, WI 54729-3511 | 2012-11-07 |
| 1225152861 | State of Wisconsin | Skilled Nursing Facility | 21425g Spring St, Union Grove, WI 53182-9707 | 2007-03-19 |
| 1235225616 | State of Wisconsin | Intermediate Care Facility, Mentally Retarded | 2820 East Park Avenue, Chippewa Falls, WI 54729-0340 | 2006-10-05 |
| 1366439986 | State of Wisconsin | Skilled Nursing Facility | N2665 County Road Qq, King, WI 54946 | 2005-09-29 |
| 1225362403 | State of Wisconsin | Durable Medical Equipment & Medical Supplies | 317 Knutson Dr, Madison, WI 53704-1133 | 2009-09-22 |
| 1336324946 | State of Wisconsin | Intermediate Care Facility, Mentally Retarded | 317 Knutson Dr, Madison, WI 53704-1133 | 2008-01-02 |
| 1588703078 | State of Wisconsin | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 317 Knutson Dr, Madison, WI 53704-1133 | 2007-02-05 |
| 1386705655 | State of Wisconsin | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 317 Knutson Dr, Madison, WI 53704-1133 | 2006-12-12 |
| 1164516506 | State of Wisconsin | Psychiatric Hospital | 1300 South Drive, Winnebago, WI 54985-0009 | 2006-10-02 |
| 1437253648 | State of Wisconsin | General Acute Care Hospital | 301 Troy Dr, Madison, WI 53704-1521 | 2006-09-08 |
| Street Address |
21425 SPRING ST |
| City | UNION GROVE |
| State | WI |
| Zip Code | 53182-9707 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1629055371 | Dina M Twigg | Nurse Practitioner | 21425 Spring St, Union Grove, WI 53182-9707 | 2005-12-23 |
| 1003473240 | Karrylyn K Kais | Speech-Language Pathologist | 21425 Spring St, Union Grove, WI 53182-9707 | 2019-05-23 |
| 1619486776 | Adam Lee Wesner | Social Worker | 21425 Spring St, Union Grove, WI 53182 | 2017-09-21 |
| 1154872497 | Sarah Katherine Kordus | Nurse Practitioner | 21425 Spring St, Union Grove, WI 53182-9707 | 2016-10-21 |
| 1508131855 | Jennifer Lynn Moreno | Social Worker | 21425 Spring St, Union Grove, WI 53182-9707 | 2012-03-20 |
| 1063709749 | Simonida Kokanovic | Family Medicine | 21425 Spring St, Union Grove, WI 53182-9707 | 2011-07-01 |
| 1821380544 | Muhammad Asad Khan | Internal Medicine | 21425 Spring St, Union Grove, WI 53182-9707 | 2011-05-13 |
| 1497056535 | Va Medical Center | Military Hospital | 21425 Spring St, Union Grove, WI 53182-9707 | 2010-11-05 |
| 1275786600 | Lorelei L Volstad | Nurse Practitioner | 21425 Spring St, Union Grove, WI 53182-9707 | 2008-10-29 |
| 1790935914 | Jerry Lee Ceilesh | Dentist | 21425 Spring St, Union Grove, WI 53182-9707 | 2008-09-24 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770134843 | Cory Harpe | Technician | 23338 18th St., Union Grove, WI 53182 | 2019-09-20 |
| 1477925121 | Michael Joseph Gillen | Psychologist | 21425 Spring Street, Union Grove Va Clinic, Union Grove, WI 53182 | 2015-10-21 |
| 1881738615 | Roxanne Roese | Nurse Practitioner | 21425b Spring Street, Union Grove, WI 53182 | 2007-02-16 |
| 1821192444 | Lynn Ann Fredrickson | Registered Nurse | 15134 Washington Ave, Union Grove, WI 53182 | 2006-09-12 |
| 1912441569 | Amie Koehnlein | Counselor | 1120 Main St, Union Grove, WI 53182 | 2016-12-15 |
| 1417337247 | Laura Brantman-johnson | Registered Nurse | 4320 67th Dr, Union Grove, WI 53182 | 2015-06-06 |
| 1932142197 | Catherine A Russell | Social Worker | Va Clinic, 21425 Spring, Union Grove, WI 53182 | 2006-06-14 |
| 1104928332 | Hospice Advantage, LLC | Hospice Care, Community Based | 951 Main St, Suite 120, Union Grove, WI 53182-1039 | 2006-09-01 |
| 1992759161 | Union Grove Yorkville Fire Rescue | Ambulance | 700 Main St, Union Grove, WI 53182-1048 | 2006-05-20 |
| 1144501099 | Joshua M Rode | Physical Therapy Assistant | 1420 Park Pl Apt 10, 10, Union Grove, WI 53182-1058 | 2011-09-06 |
| Find all providers in zip 53182 | ||||
| Taxonomy Code | 315P00000X |
| Grouping | Nursing & Custodial Care Facilities |
| Classification | Intermediate Care Facility, Mentally Retarded |
| (1) A public institution for care of the mentally retarded or people with related conditions. (2) An institution giving active treatment to mentally retarded or developmentally disabled persons or persons with related conditions. The primary purpose of the institution is to provide health or rehabilitative services to such individuals. |
| Notes: Sources: (1) Lexikon: Dictionary of Health Care Terms, Organizations and Acronyms for the Era of Reform, Joint Commission on Accreditation of Healthcare Organizations, Oakbrook Terrace, IL: 1994, p. 403 (2) Paraphrased from Code of Federal Regulations #42, Public Health, Section 440.150(c). |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1790036739 | United Care Homes of Wisconsin LLC | Intermediate Care Facility, Mentally Retarded | 338 Municipal Dr, West Bend, WI 53095-3510 | 2012-10-01 |
| 1114158029 | Mississippi Valley Health Services Commission | Intermediate Care Facility, Mentally Retarded | 902 Garland St E, West Salem, WI 54669-1308 | 2009-07-28 |
| 1891931085 | The Arc of Columbia County | Intermediate Care Facility, Mentally Retarded | 711 E Cook St, Portage, WI 53901-2300 | 2008-12-18 |
| 1871714543 | St. Coletta of Wisconsin | Intermediate Care Facility, Mentally Retarded | W4955 Us Highway 18, Jefferson, WI 53549-9702 | 2007-05-01 |
| 1841418415 | Mccarthy Nursing Home | Intermediate Care Facility, Mentally Retarded | 124 S Monroe St, Stoughton, WI 53589-2012 | 2007-04-20 |
| 1689890204 | Hoplite, Inc. | Intermediate Care Facility, Mentally Retarded | 1719 Washington Ave, Racine, WI 53403-2019 | 2007-04-18 |
| 1235225616 | State of Wisconsin | Intermediate Care Facility, Mentally Retarded | 2820 East Park Avenue, Chippewa Falls, WI 54729-0340 | 2006-10-05 |
| 1376531061 | Wi Il Senior Housing | Intermediate Care Facility, Mentally Retarded | 1002 Eueka Street, Ripon, WI 54971 | 2005-10-07 |
| 1265429278 | County of Grant - Orchard Manor Fdd | Intermediate Care Facility, Mentally Retarded | 8800 Hwy 61, Lancaster, WI 53813-9306 | 2005-10-04 |
| 1790771368 | Heyde Health System, Inc | Intermediate Care Facility, Mentally Retarded | 14135 150th Ave, Bloomer, WI 54724-4410 | 2005-09-20 |
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| City | UNION GROVE |
| Zip Code | 53182 |
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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.