NPIMap

Organization Active NPI

County of Richland

Doing business as Pine Valley Community Village

  • Skilled Nursing Facility
  • Richland Center, WI
National Provider Identifier
1144229055
Registry record updated Feb 7, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
2365 Issued in WI
Legal business name
COUNTY OF RICHLAND
Doing business as
Pine Valley Community Village
Practice address
25951 Circle View Dr
Richland Center, WI 53581-4013
Phone
(608) 647-2138
Fax
(608) 647-8955
NPI assigned
Jul 21, 2005
Last updated
Feb 7, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 7, 2024

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

Authorized official

Name
Shaponda Jimerson, ADM
Title
Administrator
Phone
(608) 647-2138

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X 2365 WI Primary
Nursing Facility Supplies (DME) 332BN1400X 2365 WI
Parenteral & Enteral Nutrition Supplies (DME) 332BP3500X 2365 WI

Addresses

Primary practice location

25951 Circle View Dr
Richland Center, WI 53581-4013

Mailing address

25951 Circle View Dr
Richland Center, WI 53581-4013
Phone (608) 647-2138

Other identifiers 1

IdentifierTypeStateIssuer
20155800MedicaidWI

Other names 1

  • Pine Valley Community Village Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20111121000287 WI Part A Provider - Skilled Nursing Facility 2264335355 Practice locations: Richland Center, WI

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1144229055. Details of each certification follow.

Skilled nursing facility certification: CCN 525365

Legal name
COUNTY OF RICHLAND
Doing business as
PINE VALLEY COMMUNITY VILLAGE
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Aug 1, 1984
Last certification
May 22, 2025
Beds
80
Ownership / control type
Corporation
Organization structure
GovernmentNon-profit
Enrollment address
25951 Circle View Dr
Richland Center, WI 53581-4013
Nursing home name
PINE VALLEY COMMUNITY VILLAGE

Other NPIs with the same Medicare PAC ID 3

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

  • County of Richland

    dba Richland County Health and Human Services

    • Primary Care Clinic/Center
    • Richland Center, WI
    • NPI 1508071960

    2264335355

    Same PAC ID
  • County of Richland

    dba Richland County Health and Human Services

    • Mental Health Clinic/Center (Including Community Mental Health Center)
    • Richland Center, WI
    • NPI 1548482011

    2264335355

    Same PAC ID
  • County of Richland

    dba Richland County Ambulance

    • Ambulance
    • Richland Center, WI
    • NPI 1568465490

    2264335355

    Same PAC ID

Care Compare: Nursing home

Medicare Care Compare
Listed as
Pine Valley Community VillageCCN 525365 · All quality measures
Overall star rating
3 of 5
Health inspections
2 of 5
Staffing
5 of 5
Quality measures
3 of 5
Type
Medicare and Medicaid
Ownership
For profit - Corporation
Certified
Aug 1, 1984
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
8066.9 residents per day on average
Penalties (3 years)
2Fines totaling $97,311

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
52D0684455Pine Valley Community Village25951 Circle View Lane, Richland Center, WI 53581Certificate of waiverAug 31, 2026

National Provider Directory

National Provider Directory
Tax ID family
Richland County Ambulance9 organizations share this tax ID, including this one

Other organizations with this tax ID 8

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

Ownership & related parties

All disclosed owners & managing parties 16

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

NameRoleSinceShare
Steve Williamson Individual Managing Control - Governing BodyCounty Board Memeber Apr 16, 2024
Julia Fleming Individual Managing Control - Governing BodyCounty Board Memeber Apr 16, 2024
County of Richland Organization, Richland Center, WI 5% Or Greater Direct Ownership Interest Mar 9, 1978 100%
Operational/Managerial Control Mar 9, 1978
Adp of the SNF Mar 9, 1978
Marc Couey Individual Managing Control - Governing BodyCounty Board Memeber Apr 16, 2024
Sarfraz Sidhu Individual Operational/Managerial Control Jan 1, 2022
Adp of the SNF Jan 1, 2022
Larry Engel Individual Managing Control - Governing BodyCounty Board Memeber Apr 16, 2024
Sandra Kramer Individual Managing Control - Governing BodyCounty Board Memeber Apr 16, 2024
Richard McKee Individual Managing Control - Governing BodyCounty Board Memeber Apr 16, 2024
Randy Schoonover Individual Managing Control - Governing BodyCounty Board Memeber May 20, 2025
Mary Miller Individual Managing Control - Governing BodyCounty Board Memeber Apr 16, 2024
Alayne Hendricks Individual Managing Control - Governing BodyCounty Board Memeber Apr 16, 2025
David Turk Individual Managing Control - Governing BodyCounty Board Memeber Apr 16, 2024
Brittany J Paulus Individual Corporate DirectorAdministrator Mar 5, 2025 100%
Operational/Managerial Control Mar 5, 2025
Adp of the SNF Mar 5, 2025
Kerry Severson Individual Managing Control - Governing BodyCounty Board Member Apr 16, 2024
Stephen Carrow Individual Managing Control - Governing BodyCounty Board Memeber Apr 16, 2024
Tiffany Thompson Individual Managing Control - Governing BodyCounty Board Memeber Oct 20, 2025

Owners & managing parties with NPI records 4

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

  • County of Richland

    dba Richland County Health and Human Services

    • Primary Care Clinic/Center
    • Richland Center, WI
    • NPI 1508071960

    5% Or Greater Direct Ownership Interest, Adp of the SNF, Operational/Managerial Control

    CMS ownership
  • County of Richland

    dba Richland County Health and Human Services

    • Mental Health Clinic/Center (Including Community Mental Health Center)
    • Richland Center, WI
    • NPI 1548482011

    5% Or Greater Direct Ownership Interest, Adp of the SNF, Operational/Managerial Control

    CMS ownership
  • County of Richland

    dba Richland County Ambulance

    • Ambulance
    • Richland Center, WI
    • NPI 1568465490

    5% Or Greater Direct Ownership Interest, Adp of the SNF, Operational/Managerial Control

    CMS ownership
  • Sarfraz Singh Sidhu, M.D.
    • Internal Medicine Physician
    • Waukesha, WI
    • NPI 1801946462

    Adp of the SNF, Operational/Managerial Control

    CMS ownership

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

Affiliated clinicians 10

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

NPI Registry JSON

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

{
    "created_epoch": "1121904000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1707264000000",
    "number": "1144229055",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "25951 CIRCLE VIEW DR",
            "city": "RICHLAND CENTER",
            "state": "WI",
            "postal_code": "535814013",
            "telephone_number": "608-647-2138",
            "fax_number": "608-647-8955"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25951 CIRCLE VIEW DR",
            "city": "RICHLAND CENTER",
            "state": "WI",
            "postal_code": "535814013",
            "telephone_number": "608-647-2138",
            "fax_number": "608-647-8955"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COUNTY OF RICHLAND",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-07-21",
        "last_updated": "2024-02-07",
        "certification_date": "2024-02-07",
        "status": "A",
        "authorized_official_last_name": "JIMERSON",
        "authorized_official_first_name": "SHAPONDA",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "608-647-2138",
        "authorized_official_credential": "ADM"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "WI",
            "license": "2365",
            "primary": true
        },
        {
            "code": "332BN1400X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Nursing Facility Supplies",
            "state": "WI",
            "license": "2365",
            "primary": false
        },
        {
            "code": "332BP3500X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Parenteral & Enteral Nutrition",
            "state": "WI",
            "license": "2365",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "20155800",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pine Valley Community Village",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Richland Center, WI

Sources for this page

Verify at the official NPI Registry.