CCG Tomah Inc.
Organization Active NPI Skilled Nursing Facility · Tomah, WI
NPI 1194723205 · NPPES record last updated Jan 23, 2008
Key facts
- NPI
- 1194723205
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Skilled Nursing Facility 314000000X
- License
- 2825 (WI)
- Legal business name
- CCG TOMAH INC.
- Practice address
- 1505 Butts Ave
Tomah, WI 54660-2405 - Phone
- (608) 372-3241
- Fax
- (608) 372-3250
- NPI assigned
- Jul 12, 2005
- Organization subpart
- No
Authorized official
- Name
- Keith Yoder
- Title
- Cfo
- Phone
- (614) 416-0600
Other NPIs on the same Medicare enrollment 1
Affiliated clinicians 3
-
Rick A Erdman, MD
-
Andrew Last, MD
-
Keshni Lata Ramnanan, M.D.
Medicare Care Compare: Nursing home
- Listed as
- Tomah Nursing and Rehab
- Overall star rating
- ★★☆☆☆ 2 of 5
- Health inspections
- ★★☆☆☆ 2 of 5
- Staffing
- ★★★☆☆ 3 of 5
- Quality measures
- ★★★☆☆ 3 of 5
- Type
- Medicare and Medicaid
- Ownership
- For profit - Limited Liability company
- Certified
- Oct 1, 1989
- Medicare certification status
- Active
- Certified beds
- 74 · 48.7 residents per day on average
- Chain
- Atrium Centers
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WI
Skilled nursing facility certification: CCN 525442
- Legal name
- ORION TOMAH LLC
- Doing business as
- TOMAH NURSING AND REHABILITATION
- Certification status
- Active
- Provider type (POS)
- Nursing home – SNF/NF dual certification
- Participating since
- Oct 1, 1989
- Last certification
- Aug 29, 2024
- Beds
- 74
- Ownership / control type
- Limited Liability Corporation
- Multi-facility organization
- Atrium Living Centers
- Organization structure
- LLC · Proprietary
- Incorporated
- Aug 21, 2007 in DE
- Enrollment address
- 1505 Butts Ave
Tomah, WI 54660-2405 - Nursing home name
- TOMAH NURSING AND REHAB
- Affiliated entity
- ATRIUM CENTERS
All disclosed owners & managing parties 10
| Name | Role | Since | Share |
|---|---|---|---|
| Essel W Bailey |
Corporate Officer |
Aug 3, 2003 | |
| Amicus Capital Holdings Inc |
5% Or Greater Indirect Ownership Interest | Jan 1, 2021 | 100% |
| Brandi Shea |
W-2 Managing Employee |
Mar 9, 2022 | |
| Michael Rocca |
Corporate Officer |
Jun 14, 2021 | |
| Susan Albright Ross |
Corporate Officer |
Dec 24, 2017 | |
| Donald D Finney |
Corporate Officer |
Aug 3, 2003 | |
| Orion Operating Services LLC |
5% Or Greater Direct Ownership Interest | Dec 1, 2007 | 100% |
| Dennis a Lockhart |
Corporate Director |
Aug 3, 2003 | |
| Atrium Centers Management LLC |
Operational/Managerial Control | Oct 1, 2007 | |
| Atrium Centers, LLC |
5% Or Greater Indirect Ownership Interest | Oct 1, 2007 | 100% |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20071127000484 | WI | Part a Provider - Skilled Nursing Facility | 7012006109 |
1 other NPI on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Tomah, WI |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Skilled Nursing Facility | 314000000X | 2825 | WI | Yes |
Addresses
Primary practice location
1505 Butts Ave
Tomah, WI 54660-2405
Mailing address
5000 Hakes Dr
Suite 600
Norton Shores, MI 49441-5574
Phone (231) 799-6870
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 20192600 | Medicaid | WI | |
| 621810991030 | Other | WI | BCBS PROVIDER CODE |
Other names
- Tomah Health Care Center
Other providers in Tomah, WI
- Kristi L Carlson
- Tracy G Carlson
- Alicia Cartwright
- Kimberly Megan Casper
- Beverly Kay Cassellius
- Brittany Cessford
- Melinda S Challoner
- Rhonda McDuffie Chambers
- James L Chitwood
- Gina Rae Chmelka
All providers in Tomah, 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 Jan 23, 2008. 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.