NPIMap

Organization Active NPI

Shell Lake SNF LLC

Doing business as Shell Lake Health Care Center

  • Nursing Facility/Intermediate Care Facility
  • Shell Lake, WI
National Provider Identifier
1295939049
Registry record updated Aug 18, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nursing Facility/Intermediate Care FacilityTaxonomy code 313M00000X
License
2748 Issued in WI
Legal business name
SHELL LAKE SNF LLC
Doing business as
Shell Lake Health Care Center
Practice address
802 E Cty Hwy B
Shell Lake, WI 54871
Phone
(715) 468-4292
Fax
(715) 468-4232
NPI assigned
Jun 14, 2007
Last updated
Aug 18, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 18, 2025

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

Authorized official

Name
Jonathon William HansenNPI 1982220265
Title
Ceo
Phone
(320) 828-7310

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nursing Facility/Intermediate Care Facility 313M00000X 2748 WI Primary
Skilled Nursing Facility 314000000X WI

Addresses

Primary practice location

802 E Cty Hwy B
Shell Lake, WI 54871

Mailing address

PO Box 642
Sauk Rapids, MN 56379-0642
Phone (320) 828-7310

Other identifiers 1

IdentifierTypeStateIssuer
2748OtherWIBUSINESS LICENSE NUMBER

Other names 1

  • Shell Lake Health Care Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210728000409 WI Part A Provider - Skilled Nursing Facility 4789087701 Practice locations: Shell Lake, WI

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1295939049. Details of each certification follow.

Skilled nursing facility certification: CCN 525553

Legal name
SHELL LAKE SNF LLC
Doing business as
SHELL LAKE HEALTH CARE CENTER
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Nov 1, 1994
Last certification
Jun 20, 2024
Beds
50
Ownership / control type
Limited Liability Corporation
Multi-facility organization
Faith Based Healthcare
Organization structure
LLCProprietary
Incorporated
May 25, 2021 in WI
Enrollment address
802 E County Highway B
Shell Lake, WI 54871-4425
Nursing home name
SHELL LAKE HEALTH CARE CENTER

Care Compare: Nursing home

Medicare Care Compare
Listed as
Shell Lake Health Care CenterCCN 525553 · All quality measures
Overall star rating
3 of 5
Health inspections
3 of 5
Staffing
4 of 5
Quality measures
3 of 5
Type
Medicare and Medicaid
Ownership
For profit - Limited Liability company
Certified
Nov 1, 1994
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
5041.5 residents per day on average

Processed by Care Compare on Aug 1, 2026.

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 10

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

NameRoleSinceShare
Jonathon W Hansen Individual 5% Or Greater Direct Ownership Interest Sep 22, 2021 50%
Operational/Managerial Control Sep 22, 2021
Adp of the SNF Sep 22, 2021
Direct Ownership Interest Sep 22, 2021 50%
Sentry Bank Organization, Saint Joseph, MN Created for acquisition, For-profit 5% Or Greater Mortgage Interest Sep 22, 2021 90%
Julie a Spore Individual 5% Or Greater Direct Ownership Interest Sep 22, 2021 50%
Adp of the SNF Sep 22, 2021
Direct Ownership Interest Sep 22, 2021 50%
Wipfli LLP Organization, Milwaukee, WI Consulting firm Operational/Managerial Control Sep 22, 2021
Adp of the SNF Jun 30, 2025
Shell Lake SNF LLC Organization, Shell Lake, WI For-profit, Owned by another organization or individual 5% Or Greater Direct Ownership Interest Sep 22, 2021 100%
Adp of the SNF Sep 22, 2021
David Colvin Individual Operational/Managerial Control May 1, 2025
Adp of the SNF May 1, 2025
Indianhead Medical Center Shell Lake, Inc. Organization, Shell Lake, WI Non-profit Adp of the SNF Sep 22, 2021
Kristina Dugger Individual Operational/Managerial Control Jun 14, 2022
Adp of the SNF Jun 14, 2022
Jennie L Klassa Individual Operational/Managerial Control Sep 22, 2021
Adp of the SNF Sep 22, 2021
Shell Lake HCC Holdings LLC Organization, Shell Lake, WI For-profit Adp of the SNF Sep 22, 2021

Owners & managing parties with NPI records 6

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

Facilities with the same owner 65

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

View all 65

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1181779200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1755475200000",
    "number": "1295939049",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 642",
            "city": "SAUK RAPIDS",
            "state": "MN",
            "postal_code": "563790642",
            "telephone_number": "320-828-7310",
            "fax_number": "320-764-2665"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "802 E CTY HWY B",
            "city": "SHELL LAKE",
            "state": "WI",
            "postal_code": "54871",
            "telephone_number": "715-468-4292",
            "fax_number": "715-468-4232"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHELL LAKE SNF LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-14",
        "last_updated": "2025-08-18",
        "certification_date": "2025-08-18",
        "status": "A",
        "authorized_official_last_name": "HANSEN",
        "authorized_official_first_name": "JONATHON",
        "authorized_official_middle_name": "WILLIAM",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "320-828-7310"
    },
    "taxonomies": [
        {
            "code": "313M00000X",
            "taxonomy_group": "",
            "desc": "Nursing Facility/Intermediate Care Facility",
            "state": "WI",
            "license": "2748",
            "primary": true
        },
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "WI",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BUSINESS LICENSE NUMBER",
            "identifier": "2748",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Shell Lake Health Care Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Shell Lake, WI

Sources for this page

Verify at the official NPI Registry.