NPIMap

Organization Active NPI

Wisconsin Illinois Senior Housing Inc.

  • Skilled Nursing Facility
  • East Troy, WI
National Provider Identifier
1043463961
Registry record updated May 13, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
WISCONSIN ILLINOIS SENIOR HOUSING INC.
Practice address
3271 North St
East Troy, WI 53120-1147
Phone
(262) 642-3995
Fax
(262) 642-3930
NPI assigned
Oct 23, 2008
Last updated
May 13, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 13, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mrs. Stephanie L. Sherman
Title
Medicare Program Monitor
Phone
(303) 980-0611

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X WI Primary

Addresses

Primary practice location

3271 North St
East Troy, WI 53120-1147

Mailing address

3271 North St
East Troy, WI 53120-1147
Phone (262) 642-3995

Other names 1

  • East Troy Manor Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090203000536 WI Part A Provider - Skilled Nursing Facility 3577649797 Practice locations: East Troy, WI

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1043463961. Details of each certification follow.

Skilled nursing facility certification: CCN 525561

Legal name
WISCONSIN ILLINOIS SENIOR HOUSING INC
Doing business as
EAST TROY MANOR
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Apr 1, 1995
Last certification
Aug 15, 2024
Beds
50
Ownership / control type
Nonprofit Corporation
Multi-facility organization
WISH - CARRIAGE HEALTHCARE
Organization structure
CorporationNon-profit
Incorporated
Nov 21, 1994 in WI
Enrollment address
3271 North St
East Troy, WI 53120-1147
Nursing home name
EAST TROY MANOR
Affiliated entity
WISCONSIN ILLINOIS SENIOR HOUSING, INC.

Other NPIs with the same Medicare PAC ID 6

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Care Compare: Nursing home

Medicare Care Compare
Listed as
East Troy ManorCCN 525561 · All quality measures
Overall star rating
2 of 5
Health inspections
2 of 5
Staffing
3 of 5
Quality measures
4 of 5
Type
Medicare and Medicaid
Ownership
Non profit - Corporation
Certified
Apr 1, 1995
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
5041.9 residents per day on average
Chain
Wisconsin Illinois Senior Housing, Inc.7 facilities in the chain
Penalties (3 years)
4Fines totaling $129,433

Processed by Care Compare on Aug 1, 2026.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
52D0389139East Troy Manor3271 North St, East Troy, WI 53120Certificate of waiverAug 31, 2026

National Provider Directory

National Provider Directory
Tax ID family
Wisconsin Illinois Senior Housing Inc8 organizations share this tax ID, including this one

Other organizations with this tax ID 7

Organizations that report the same tax identification number in the National Provider Directory.

Member organizations 4

Organizations listed as members of this organization in the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 22

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Rehab Solutions Group, LLC Organization, Kohler, WI Consulting firm Operational/Managerial Control Jan 1, 2024
Adp of the SNF Aug 18, 2025
Andrew C. Kerwin Individual Corporate DirectorChairman of the Board Jun 26, 2009
Individual Adp of the SNF Jan 1, 2024
Christie Leadley Individual Operational/Managerial Control May 2, 2023
Adp of the SNF May 2, 2023
Partners in Wealth Management, Inc Organization, Naperville, IL Investment firm Operational/Managerial Control Jan 1, 2024
Adp of the SNF Aug 18, 2025
Lori Dupont Individual Corporate DirectorTreasurer Jan 25, 2016
Robert V. Siebel Individual Operational/Managerial Control Oct 1, 1999 100%
Adp of the SNF Oct 1, 1999
Individual Adp of the SNF Jan 1, 1995
Sarfraz Sidhu Individual Operational/Managerial Control Oct 10, 2022
Adp of the SNF Oct 10, 2022
Carriage Healthcare Companies Inc Organization, Lakewood, CO Corporation, Management services company, For-profit Operational/Managerial Control Feb 15, 2001 100%
Adp of the SNF Oct 6, 2025
JT and Associates LLC Organization, Elm Grove, WI LLC Operational/Managerial Control Jan 1, 2010
Adp of the SNF Feb 5, 2026
Pinion, LLC Organization, Great Falls, MT LLC Operational/Managerial Control Jan 1, 1995
Adp of the SNF Aug 18, 2025
Individual Adp of the SNF Jan 1, 1995
Miriam Gehler Individual Corporate DirectorBoard Member Mar 14, 2011
Stephanie L Sherman Individual Operational/Managerial Control Aug 12, 2012
Adp of the SNF Aug 12, 2012
Individual Adp of the SNF Jan 1, 2010
Karen M Lacke (Carrig) Individual Corporate DirectorBoard Member Jan 1, 2016
HBT It LLC Organization, Bridgeville, PA LLC Operational/Managerial Control Jul 1, 2024
Adp of the SNF Aug 18, 2025
Keri Gerlach Individual Corporate DirectorBoard Member Jan 1, 2019
Nicholas Lynn Individual Corporate DirectorBoard Member Mar 14, 2011
Individual Adp of the SNF Jan 1, 2024
Rajeev Shiva Kumar Individual Corporate DirectorBoard Member Apr 24, 2012

Owners & managing parties with NPI records 2

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

All facility ownership & control disclosures 3

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Transitions at Home, Inc.Elkhorn, WI, CCN 527325 Home health agency 5% Or Greater Direct Ownership Interest (100%) Nov 22, 2011
Transitions Home Health of Central WisconsinStevens Point, WI, CCN 527330 Home health agency 5% Or Greater Direct Ownership Interest (100%) Nov 22, 2011
Transitions at Home of Western WiMount Horeb, WI, CCN 527341 Home health agency 5% Or Greater Direct Ownership Interest (100%) Jun 4, 2020

Owned or controlled facilities with NPI records 3

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Facilities with the same owner 11

Facilities that share an organizational owner with 5% or greater ownership or operational control.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1224720000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1589328000000",
    "number": "1043463961",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3271 NORTH ST",
            "city": "EAST TROY",
            "state": "WI",
            "postal_code": "531201147",
            "telephone_number": "262-642-3995",
            "fax_number": "262-642-3930"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3271 NORTH ST",
            "city": "EAST TROY",
            "state": "WI",
            "postal_code": "531201147",
            "telephone_number": "262-642-3995",
            "fax_number": "262-642-3930"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WISCONSIN ILLINOIS SENIOR HOUSING INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-10-23",
        "last_updated": "2020-05-13",
        "certification_date": "2020-05-13",
        "status": "A",
        "authorized_official_last_name": "SHERMAN",
        "authorized_official_first_name": "STEPHANIE",
        "authorized_official_middle_name": "L.",
        "authorized_official_title_or_position": "MEDICARE PROGRAM MONITOR",
        "authorized_official_telephone_number": "303-980-0611",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "WI",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "East Troy Manor",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "East Troy Manor",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in East Troy, WI

Sources for this page

Verify at the official NPI Registry.