Clement Manor, Inc.
Organization Active NPI Skilled Nursing Facility · Greenfield, WI
NPI 1114923935 · NPPES record last updated Aug 22, 2020
Key facts
- NPI
- 1114923935
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Skilled Nursing Facility 314000000X
- License
- 2724 (WI)
- Legal business name
- CLEMENT MANOR, INC.
- Practice address
- 3939 S 92ND St
Greenfield, WI 53228-2140 - Phone
- (414) 321-1800
- Fax
- (414) 546-7357
- NPI assigned
- Jun 27, 2005
- Organization subpart
- No
Authorized official
- Name
- Dennis Ferger
- Title
- Administrator
- Phone
- (414) 546-7330
Owners & managing parties with NPI records 1
-
Steve I Chang, MD
Member organizations 7
Facilities with the same owner 14
Affiliated clinicians 2
-
Steve I Chang, MD
-
Kieran McAvoy, MD
Medicare Care Compare: Nursing home
- Listed as
- Clement Manor Health Care Center
- Overall star rating
- ★☆☆☆☆ 1 of 5
- Health inspections
- ★☆☆☆☆ 1 of 5
- Staffing
- ★★★☆☆ 3 of 5
- Quality measures
- ★★★☆☆ 3 of 5
- Type
- Medicare and Medicaid
- Ownership
- Non profit - Church related
- Certified
- Nov 3, 1982
- Medicare certification status
- Active
- Certified beds
- 50 · 44.2 residents per day on average
- Chain
- Franciscan Sisters of Christian Charity
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 52D0392099 | Clement Manor Health Center | Certificate of waiver | Aug 31, 2026 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WI
Skilled nursing facility certification: CCN 525327
- Legal name
- CLEMENT MANOR, INC.
- Doing business as
- CLEMENT MANOR HEALTH CARE CENTER
- Certification status
- Active
- Provider type (POS)
- Nursing home – SNF/NF dual certification
- Participating since
- Nov 3, 1982
- Last certification
- Dec 12, 2024
- Beds
- 50
- Ownership / control type
- Church Related
- Organization structure
- Corporation · Non-profit
- Incorporated
- Jan 15, 1963 in WI
- Enrollment address
- 3939 S 92ND St
Greenfield, WI 53228-2140 - Nursing home name
- CLEMENT MANOR HEALTH CARE CENTER
- Affiliated entity
- FRANCISCAN SISTERS OF CHRISTIAN CHARITY
All disclosed owners & managing parties 9
| Name | Role | Since | Share |
|---|---|---|---|
| Judeen Schulte |
Corporate Officer |
Nov 1, 2009 | |
| Philip Dougherty |
Corporate Director | Jan 1, 2015 | |
| Steve I Chang |
Contracted Managing Employee |
Sep 1, 2021 | |
| Franciscan Sisters of Christian Charity Sponsored Ministries Inc |
Operational/Managerial Control | Apr 1, 2024 | |
| Dennis Ferger |
Corporate Officer |
Jan 4, 2000 | 100% |
| W-2 Managing Employee | Aug 20, 1984 | ||
| John Heindel |
Corporate Officer |
Nov 15, 2021 | |
| Timothy E Loch |
Contracted Managing Employee |
Apr 1, 2024 | |
| Carly Loewus |
W-2 Managing Employee |
May 18, 2020 | |
| Ann Maher |
Corporate Officer |
Nov 15, 2020 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20100728000198 | WI | Part a Provider - Skilled Nursing Facility | 7012934730 | Practice locations: Greenfield, WI |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Skilled Nursing Facility | 314000000X | 2724 | WI | Yes |
Addresses
Primary practice location
3939 S 92ND St
Greenfield, WI 53228-2140
Mailing address
3939 S 92ND St
Greenfield, WI 53228-2140
Phone (414) 321-1800
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 20113300 | Medicaid | WI |
Other providers in Greenfield, WI
- Cigno Family Dental S.C.
- Antonio G Cigno
- City of Greenfield
- City of Greenfield
- Christopher Bruce Clark
- Rosanne B Clement
- Mary E. Clementi
- Madison Elizabeth Coady
- Joanne Marie Colombo Hughes
- Commonwealth Dialysis Center, LLC
All providers in Greenfield, WI · Skilled Nursing Facility in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 22, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.