ST. COLETTA OF WISCONSIN (NPI# 1871714543) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1871714543 |
| Entity Type | Organization |
| Organization Name | ST. COLETTA OF WISCONSIN |
| Practice Address |
W4955 Us Highway 18 Jefferson WI 53549-9702 |
| Practice Telephone | 9206744330 |
| Practice Fax Number | 9206748422 |
| Mailing Telephone | 9206744330 |
| Mailing Fax Number | 9206748422 |
| Enumeration Date | 2007-05-01 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | MR. JOHN HEINDEL (VICE PRESIDENT FINANCIAL SERVICES) |
| Authorized Official Telephone | 9206748287 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 315P00000X | Intermediate Care Facility, Mentally Retarded | 1109 | WI | Nursing & Custodial Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WI | PROVIDER NUMBER | 20009700 | 01 |
| Street Address |
W4955 US HIGHWAY 18 |
| City | JEFFERSON |
| State | WI |
| Zip Code | 53549-9702 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1740804913 | Anna E Warzala | Licensed Practical Nurse | Sunset Ridge Jefferson, 826 E. Reinel Street, Jefferson, Wi 53549, Jefferson, WI 53549 | 2020-06-03 |
| 1023428083 | Mary Beth Breunig | Occupational Therapist | 206 South Taft Avenue, Jefferson, WI 53549 | 2014-04-30 |
| 1841639952 | Debra Lee Schoenike | Licensed Practical Nurse | 610 S Main Street, Jefferson, WI 53549 | 2013-06-21 |
| 1073762191 | Katherine Sue Drechsler | Counselor | 1541 Annex Road, Jefferson, WI 53549 | 2008-09-12 |
| 1497960645 | Family Resources Associates Inc | Counselor | 248 S Wisconsin Drive, Jefferson, WI 53549 | 2007-05-11 |
| 1386707529 | Todd G Goldbeck | Physical Therapist | 1515 Highway 26 South, Jefferson, WI 53549 | 2006-12-19 |
| 1982780813 | Sport & Spine Clinic of Fort Atkinson Limited Partnership | Physical Therapist | 222 S Wisconsin Drive, Suite 3, Jefferson, WI 53549 | 2006-10-31 |
| 1033202528 | Marie Ann Maxwell-jones | Occupational Therapist | N3995 Annex Road, Jefferson, WI 53549 | 2006-10-02 |
| 1447216551 | Diane Mary Voelker | Registered Nurse | 224 Connelly D R, Jefferson, WI 53549 | 2006-04-26 |
| 1063477065 | Cynthia Lynn Miller | Registered Nurse | W4949 Streim Lane, Jefferson, WI 53549 | 2006-04-20 |
| Find all providers in zip 53549 | ||||
| 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 |
|---|---|---|---|---|
| 1700324084 | Magnolia Community Services, Inc | Intermediate Care Facility, Mentally Retarded | 821 Jefferson Heights Ave., Jefferson, LA 70121 | 2017-02-07 |
| 1801260468 | Magnolia Community Services, Inc | Intermediate Care Facility, Mentally Retarded | 143 Central Ave, Jefferson, LA 70121-3401 | 2015-11-19 |
| 1013052315 | Rha Health Services Nc, LLC | Intermediate Care Facility, Mentally Retarded | 348 Thomas St, Jefferson, NC 28640-9634 | 2007-02-21 |
| 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 |
| 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 |
| 1891781464 | Lakeview Health Center | Intermediate Care Facility, Mentally Retarded | 902 E Garland St, West Salem, WI 54669-1308 | 2005-09-20 |
| Find all providers with the same taxonomy | ||||
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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.