NPIMap

Organization Active NPI

Plum City Care Center, Inc.

  • Skilled Nursing Facility
  • Plum City, WI
National Provider Identifier
1275743387
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
3171 Issued in WI
Legal business name
PLUM CITY CARE CENTER, INC.
Practice address
301 Cherry Ave W
Plum City, WI 54761-9781
Phone
(715) 647-2401
NPI assigned
May 23, 2007
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Amy Fetzer
Title
Administrator
Phone
(715) 647-2401

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X 3171 WI Primary

Addresses

Primary practice location

301 Cherry Ave W
Plum City, WI 54761-9781

Mailing address

301 Cherry Ave W
Plum City, WI 54761-9781
Phone (715) 647-2401

Other identifiers 1

IdentifierTypeStateIssuer
20176400MedicaidWI

Other names 1

  • Eau Claire Manor, Inc Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20111201000361 WI Part A Provider - Skilled Nursing Facility 6002080074 Practice locations: Plum City, WI

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1275743387. Details of each certification follow.

Skilled nursing facility certification: CCN 525440

Legal name
PLUM CITY CARE CENTER, INC.
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Oct 1, 1989
Last certification
Jan 8, 2025
Beds
50
Ownership / control type
Corporation
Organization structure
CorporationProprietary
Incorporated
Jun 23, 1987 in WI
Enrollment address
301 Cherry Ave W
Plum City, WI 54761-9781
Nursing home name
PLUM CITY CARE CTR
Affiliated entity
REAL PROPERTY HEALTH FACILITIES

Care Compare: Nursing home

Medicare Care Compare
Listed as
Plum City Care CtrCCN 525440 · All quality measures
Overall star rating
5 of 5
Health inspections
4 of 5
Staffing
4 of 5
Quality measures
5 of 5
Type
Medicare and Medicaid
Ownership
For profit - Corporation
Certified
Oct 1, 1989
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
5043.0 residents per day on average
Chain
Real Property Health Facilities9 facilities in the chain

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
52D0396879Plum City Care Center301 Cherry St West, Plum City, WI 54761Certificate of waiverAug 31, 2026

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 6

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

NameRoleSinceShare
Dawn M Marsh Individual Corporate OfficerVP Apr 15, 1994 35%
Albert V Haworth Individual Corporate OfficerPresident,Ceo May 1, 2021 15%
Operational/Managerial ControlPresident,Ceo May 1, 2021 5%
Real Property Health Facilities Corp Organization, Las Vegas, NV Corporation Operational/Managerial Control Aug 1, 1989 100%
Christina J Penn Individual 5% Or Greater Indirect Ownership InterestIndirect Owner Jun 1, 2015 100%
Other Jun 1, 2015 100%
Carla Hutter Individual W-2 Managing EmployeeAdministrator Nov 16, 2014 50%
Christina Jayne Penn Management Trust Organization, Las Vegas, NV 5% Or Greater Direct Ownership Interest Nov 1, 2010 100%

Facilities with the same owner 8

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

Practitioners & affiliated clinicians

Affiliated clinicians 1

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": "1179878400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1275743387",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "301 CHERRY AVE W",
            "city": "PLUM CITY",
            "state": "WI",
            "postal_code": "547619781",
            "telephone_number": "715-647-2401"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "301 CHERRY AVE W",
            "city": "PLUM CITY",
            "state": "WI",
            "postal_code": "547619781",
            "telephone_number": "715-647-2401"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PLUM CITY CARE CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-23",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "FETZER",
        "authorized_official_first_name": "AMY",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "715-647-2401"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "WI",
            "license": "3171",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "20176400",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Eau Claire Manor, Inc",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Plum City, WI

Sources for this page

Verify at the official NPI Registry.