Cloverleaf Healthcare LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

Legal business name

CLOVERLEAF HEALTHCARE LLC

Practice address

1625 E Main St
Clintonville, WI 54929

Phone

(715) 823-3135

Fax

(715) 823-1503

NPI assigned

Mar 17, 2014

Organization subpart

No

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

Authorized official

Name

Soon Burnam

Title

Treasurer

Phone

(949) 540-1249

Specialties & licenses 1

Addresses

Other names 1

• The Pines Post Acute and Memory Care Doing business as

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in WI

Enrollment records 1

Skilled nursing facility certification: CCN 525497

Legal name

CLOVERLEAF HEALTHCARE LLC

Doing business as

THE PINES POST ACUTE AND MEMORY CARE

Certification status

Active

Provider type (POS)

Nursing home – SNF/NF dual certification

Participating since

Nov 1, 1992

Last certification

May 15, 2024

Beds

50

Ownership / control type

Corporation

Multi-facility organization

Ensign Services

Organization structure

LLCProprietary

Enrollment address

1625 E Main St
Clintonville, WI 54929-8407

Nursing home name

THE PINES POST ACUTE AND MEMORY CARE

Affiliated entity

THE ENSIGN GROUP

Locations

All disclosed owners & managing parties 14

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

Owners & managing parties with NPI records 1

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

• Shayna Kamin, DO

  • Geriatric Medicine (Family Medicine) Physician
  • Appleton, WI
  • NPI 1609281567

  Adp of the SNF, Managing Control - Governing Body, Operational/Managerial Control

  CMS ownership

Facilities with the same owner 2

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

• St Paul Elder Services, Inc

  • Skilled Nursing Facility
  • Kaukauna, WI
  • NPI 1093786543

  PRN Health Services, Inc.

  CMS ownership
• Wolf River Healthcare LLC

  • Skilled Nursing Facility
  • Clintonville, WI
  • NPI 1811313604

  J Thompson Staffing Inc, PRN Health Services, Inc.

  CMS ownership

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Shayna Kamin, DO

  • Geriatric Medicine (Family Medicine) Physician
  • Appleton, WI
  • NPI 1609281567
  NPD (past)

Clinicians who list this facility as an affiliation in Medicare Care Compare.

• Shayna Kamin, DO

  • Geriatric Medicine (Family Medicine) Physician
  • Appleton, WI
  • NPI 1609281567

  Nursing home

  Care Compare affiliation

Listed as

The Pines Post Acute and Memory CareCCN 525497

Overall star rating

4 of 5

Health inspections

3 of 5

Staffing

2 of 5

Quality measures

5 of 5

Type

Medicare and Medicaid

Ownership

For profit - Corporation

Certified

Nov 1, 1992

Medicare certification status

ActiveFrom the Provider of Services file

Certified beds

5044.9 residents per day on average

Chain

The Ensign Group342 facilities in the chain

Penalties (3 years)

1Fines totaling $11,960

Processed by Care Compare on Aug 1, 2026.

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

CLIA laboratory certificates

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

{
    "created_epoch": "1395014400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1695081600000",
    "number": "1104242999",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1625 E MAIN ST",
            "city": "CLINTONVILLE",
            "state": "WI",
            "postal_code": "549298407",
            "telephone_number": "715-823-3135",
            "fax_number": "715-823-1503"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1625 E MAIN ST",
            "city": "CLINTONVILLE",
            "state": "WI",
            "postal_code": "54929",
            "telephone_number": "715-823-3135",
            "fax_number": "715-823-1503"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLOVERLEAF HEALTHCARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-03-17",
        "last_updated": "2023-09-19",
        "certification_date": "2023-09-19",
        "status": "A",
        "authorized_official_last_name": "BURNAM",
        "authorized_official_first_name": "SOON",
        "authorized_official_title_or_position": "TREASURER",
        "authorized_official_telephone_number": "949-540-1249"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "WI",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://199.119.81.30:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRResponse_Service",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113833.3.1066.1",
            "affiliationName": "eSolutions Inc.",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CSV",
            "address_1": "8215 W 108th Ter",
            "city": "Overland Park",
            "state": "KS",
            "country_code": "US",
            "postal_code": "662101661",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "The Pines Post Acute and Memory Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Shannon Buettner
• Cheryl Mae Chapin, M.S., LPC
• Clintonville Area Ambulance Service
• Clintonville Chiropractic Inc
• Clintonville Public School District
• John W. Connelly, D.D.S
• Daryl Daane, RPH
• Lauren E Dailey, PA
• Joanna L Davies, RN
• Patricia Delwiche, NP

• All providers in Clintonville, WI
• Skilled Nursing Facility in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 19, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.