NPIMap

Organization Active NPI

Southport Healthcare LLC

  • Home Health Agency
  • Kenosha, WI
National Provider Identifier
1285352500
Registry record updated Dec 19, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
Legal business name
SOUTHPORT HEALTHCARE LLC
Practice address
600 52ND St Ste 300
Kenosha, WI 53140-3423
Phone
(262) 656-8400
NPI assigned
Aug 22, 2022
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 19, 2025

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

Authorized official

Name
Amber L Tueller
Title
Secretary
Phone
(208) 207-2726

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X Primary

Addresses

Primary practice location

600 52ND St Ste 300
Kenosha, WI 53140-3423

Mailing address

600 52ND St Ste 300
Kenosha, WI 53140-3423
Phone (262) 656-8400

Other names 2

  • Kenosha Visiting Nurse Association Doing business as
  • Preceptor Home Health South Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20221126000085 WI Part A Provider - Home Health Agency 3678941531 Practice locations: Kenosha, WI

Home health agency certification: CCN 527024

Legal name
SOUTHPORT HEALTHCARE LLC
Doing business as
PRECEPTOR HOME HEALTH SOUTH
Certification status
Active
Provider type (POS)
Home health agency
Participating since
Jul 1, 1966
Last certification
Oct 17, 2018
Ownership / control type
Proprietary
Organization structure
LLCProprietary
Incorporated
Aug 4, 2022 in NV
Enrollment address
600 52ND St
Ste 300
Kenosha, WI 53140-3423

Other NPIs with the same Medicare PAC ID 1

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 Health SouthCCN 527024
Overall star rating
4 of 5
Ownership
Proprietary
Certified
Jul 1, 1966
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
Kenosha Visiting Nurse Association3 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.

Ownership & related parties

All disclosed owners & managing parties 8

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 5% Or Greater Direct Ownership Interest Nov 1, 2022 100%
Brent Mills Individual Corporate OfficerTreasurer Mar 26, 2026
Brent Guerisoli Individual Corporate DirectorDirector and Sole Board Member Nov 1, 2022
Kamryn Hallman Individual W-2 Managing EmployeeAd; May 19, 2026
The Pennant Group Inc Organization, Eagle, ID Corporation, For-profit 5% Or Greater Indirect Ownership Interest Nov 1, 2022 100%
John J Gochnour Individual Corporate OfficerPresident / LLC Manager Jul 23, 2024
Amber Tueller Individual Corporate OfficerSecretary Apr 10, 2024
Elliot McMillan Individual Corporate OfficerVice President Apr 10, 2024

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
Nov 1, 2022 Change of OwnershipThis provider was the buyer Kenosha Visiting Nurse Association, Inc.CCN 527024, WI, NPI 1215900154

Change of ownership 1

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

Practitioners & affiliated clinicians

Affiliated clinicians 15

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

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1661126400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1766102400000",
    "number": "1285352500",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "600 52ND ST STE 300",
            "city": "KENOSHA",
            "state": "WI",
            "postal_code": "531403423",
            "telephone_number": "262-656-8400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "600 52ND ST STE 300",
            "city": "KENOSHA",
            "state": "WI",
            "postal_code": "531403423",
            "telephone_number": "262-656-8400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHPORT HEALTHCARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-08-22",
        "last_updated": "2025-12-19",
        "certification_date": "2025-12-19",
        "status": "A",
        "authorized_official_last_name": "TUELLER",
        "authorized_official_first_name": "AMBER",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "SECRETARY",
        "authorized_official_telephone_number": "208-207-2726"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Kenosha Visiting Nurse Association",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Preceptor Home Health South",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Kenosha, WI

Sources for this page

Verify at the official NPI Registry.