NPIMap

Organization Active NPI

Great Lakes Healthcare, Inc.

Doing business as Preceptor Home Health

  • Home Health Agency
  • Germantown, WI
National Provider Identifier
1255996740
Registry record updated Aug 11, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
Legal business name
GREAT LAKES HEALTHCARE, INC.
Doing business as
Preceptor Home Health
Practice address
W175N11117 Stonewood Dr Ste 100
Germantown, WI 53022
Phone
(262) 293-3951
NPI assigned
May 9, 2019
Last updated
Aug 11, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 11, 2023

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

Authorized official

Name
Lee Johnson
Title
Treasurer
Phone
(208) 401-1369

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X Primary

Addresses

Primary practice location

W175N11117 Stonewood Dr Ste 100
Germantown, WI 53022

Mailing address

W175N11117 Stonewood Dr Ste 100
Germantown, WI 53022-6505
Phone (262) 293-3951

Other practice location 1

1211 Rickmeyer Dr Ste A
Fond Du Lac, WI 54937-2214
Phone (920) 827-4555

Other practice location 2

20875 Crossroads Cir Ste 850
Waukesha, WI 53186-4093
Phone (262) 290-4590

Other practice location 3

446 N Westhill Blvd Ste D
Appleton, WI 54914-6532
Phone (920) 797-4497

Other names 1

  • Preceptor Home Health Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20190626003112 WI Part A Provider - Home Health Agency 5395079719 Practice locations: Appleton, WI; Fond Du Lac, WI; Germantown, WI; Sheboygan, WI; Waukesha, WI

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1255996740. Details of each certification follow.

Home health agency certification: CCN 527313

Legal name
GREAT LAKES HEALTHCARE INC
Doing business as
PRECEPTOR HOME HEALTH
Certification status
Active
Provider type (POS)
Home health agency
Participating since
Apr 11, 2011
Last certification
Sep 26, 2016
Ownership / control type
Proprietary
Organization structure
CorporationProprietary
Enrollment address
W175N11117 Stonewood Dr
Ste 100
Germantown, WI 53022-6505
HHA Branch

Other NPIs with the same Medicare PAC ID 2

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

Care Compare: Home health agency

Medicare Care Compare
Listed as
Preceptor Home HealthCCN 527313 · All quality measures
Overall star rating
4.5 of 5
Ownership
Proprietary
Certified
Apr 11, 2011
Medicare certification status
ActiveFrom the Provider of Services file
Services
Nursing, Medical social, Home health aide, Physical therapy, Speech pathology, Occupational therapy

National Provider Directory

National Provider Directory
Tax ID family
Great Lakes Healthcare Inc3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

Locations

446 N Westhill Blvd
Ste D
Appleton, WI 54914
Phone (920) 797-4497

1211 Rickmeyer Dr
Ste A
Fond du Lac, WI 54937
Phone (920) 827-4555

Ownership & related parties

All disclosed owners & managing parties 7

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

NameRoleSinceShare
Cornerstone Healthcare Inc Organization, Eagle, ID Corporation, For-profit, Owned by another organization or individual 5% Or Greater Direct Ownership Interest Jun 1, 2019 100%
Brent Mills Individual Corporate OfficerTreasurer Mar 26, 2026
Brent Guerisoli Individual Corporate DirectorDirector & Sole Board Member Mar 5, 2023
The Pennant Group Inc Organization, Eagle, ID Corporation, For-profit 5% Or Greater Indirect Ownership Interest Oct 1, 2019 100%
Rich Firth Individual W-2 Managing EmployeeAdministrator Oct 15, 2022
John J Gochnour Individual Corporate OfficerPresident Jan 19, 2024
Amber Tueller Individual Corporate OfficerSecretary Mar 12, 2025

Facilities with the same owner 141

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

View all 141

Change-of-ownership history 1

DateEventCounterparty
Jun 1, 2019 Change of OwnershipThis provider was the buyer Easy Living Home Health Care Agency IncCCN 527313, WI, NPI 1609195239

Change of ownership 1

Medicare changes of ownership in which this facility was the buyer or the seller.

Practitioners & affiliated clinicians

Affiliated clinicians 53

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

View all 53

NPI Registry JSON

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

{
    "created_epoch": "1557360000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1691712000000",
    "number": "1255996740",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "W175N11117 STONEWOOD DR STE 100",
            "city": "GERMANTOWN",
            "state": "WI",
            "postal_code": "530226505",
            "telephone_number": "262-293-3951"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "W175N11117 STONEWOOD DR STE 100",
            "city": "GERMANTOWN",
            "state": "WI",
            "postal_code": "53022",
            "telephone_number": "262-293-3951"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1211 Rickmeyer Dr Ste A",
            "address_purpose": "LOCATION",
            "city": "Fond Du Lac",
            "state": "WI",
            "postal_code": "549372214",
            "country_code": "US",
            "telephone_number": "920-827-4555",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "20875 Crossroads Cir Ste 850",
            "address_purpose": "LOCATION",
            "city": "Waukesha",
            "state": "WI",
            "postal_code": "531864093",
            "country_code": "US",
            "telephone_number": "262-290-4590",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "446 N Westhill Blvd Ste D",
            "address_purpose": "LOCATION",
            "city": "Appleton",
            "state": "WI",
            "postal_code": "549146532",
            "country_code": "US",
            "telephone_number": "920-797-4497",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "GREAT LAKES HEALTHCARE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-05-09",
        "last_updated": "2023-08-11",
        "certification_date": "2023-08-11",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "LEE",
        "authorized_official_title_or_position": "TREASURER",
        "authorized_official_telephone_number": "208-401-1369"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Preceptor Home Health",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Germantown, WI

Sources for this page

Verify at the official NPI Registry.