NPIMap

Organization Active NPI

Great Lakes Hospice LLC

  • Community Based Hospice Care Agency
  • Glendale, WI
National Provider Identifier
1205433778
Registry record updated Feb 7, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Based Hospice Care AgencyTaxonomy code 251G00000X
Legal business name
GREAT LAKES HOSPICE LLC
Practice address
5150 N Port Washington Rd Ste 152
Glendale, WI 53217-5453
Phone
(262) 349-5753
NPI assigned
Oct 7, 2020
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
Jeffrey Hoehn
Title
Coo
Phone
(414) 962-5250

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community Based Hospice Care Agency 251G00000X Primary

Addresses

Primary practice location

5150 N Port Washington Rd Ste 152
Glendale, WI 53217-5453

Mailing address

5150 N Port Washington Rd Ste 152
Glendale, WI 53217-5453
Phone (414) 885-0909

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20201030000306 WI Part A Provider - Hospice 9830509900 Practice locations: Glendale, WI

Hospice certification: CCN 521608

Legal name
GREAT LAKES HOSPICE LLC
Doing business as
NORTH SHORE AT HOME
Certification status
Active
Provider type (POS)
Hospice
Participating since
Oct 7, 2021
Last certification
Oct 7, 2021
Ownership / control type
Other
Organization structure
LLCProprietary
Enrollment address
5150 N Port Washington Rd
Ste 152
Glendale, WI 53217-5453

All disclosed owners & managing parties 9

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

NameRoleSinceShare
Brian Purtell Individual 5% Or Greater Indirect Ownership Interest Jul 1, 2022 5%
David Mills Individual 5% Or Greater Indirect Ownership Interest Jul 1, 2022 8.55%
Peter Ritchie Individual W-2 Managing EmployeeAd; Apr 30, 2026 100%
Operational/Managerial ControlAdministrator Apr 30, 2026 100%
Jeffrey C Hoehn Individual 5% Or Greater Indirect Ownership InterestC.E.O. Jul 1, 2022 36.5%
Corporate DirectorDirector Jul 1, 2022 100%
Troy T Baumann Individual 5% Or Greater Indirect Ownership Interest Jul 1, 2022 36.5%
Peter a Capelli Individual Contracted Managing EmployeeMD; Apr 1, 2025
Glhos Wi LLC Organization, Milwaukee, WI LLC 5% Or Greater Direct Ownership Interest Sep 15, 2020 100%
Arrowhead 123 LLC Organization, Sandy, UT LLC 5% Or Greater Indirect Ownership Interest Jul 1, 2022 8.55%
Lane Morrell Bowen Individual 5% Or Greater Indirect Ownership Interest Jul 1, 2022 8.55%

National Provider Directory

National Provider Directory

Locations

5150 N Port Washington Rd
Ste 152
Glendale, WI 53217
Phone (262) 349-5753

Owners & managing parties with NPI records 1

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

Facilities with the same owner 15

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

View all 15

Affiliated clinicians 11

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

Care Compare: Hospice

Medicare Care Compare
Listed as
North Shore at HomeCCN 521608
Ownership
Other
Certified
Oct 7, 2021
Medicare certification status
ActiveFrom the Provider of Services file

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
52D2212848Great Lakes Hospice LLC5150 N Port Washington Rd, Glendale, WI 53217Certificate of waiverFeb 7, 2027

NPI Registry JSON

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

{
    "created_epoch": "1602028800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1707264000000",
    "number": "1205433778",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5150 N PORT WASHINGTON RD STE 152",
            "city": "GLENDALE",
            "state": "WI",
            "postal_code": "532175453",
            "telephone_number": "414-885-0909",
            "fax_number": "414-885-0922"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5150 N PORT WASHINGTON RD STE 152",
            "city": "GLENDALE",
            "state": "WI",
            "postal_code": "532175453",
            "telephone_number": "262-349-5753"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREAT LAKES HOSPICE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-10-07",
        "last_updated": "2024-02-07",
        "certification_date": "2024-02-07",
        "status": "A",
        "authorized_official_last_name": "HOEHN",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "414-962-5250"
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Glendale, WI

Sources for this page

Verify at the official NPI Registry.