Divine Rehabilitation and Nursing at Fennimore LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

Legal business name

DIVINE REHABILITATION AND NURSING AT FENNIMORE LLC

Practice address

1850 11TH St
Fennimore, WI 53809-1612

Phone

(608) 822-6100

NPI assigned

Jan 30, 2019

Last updated

Jan 14, 2025By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Isaak Markovits

Title

Managing Member

Phone

(718) 753-0250

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in WI

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1306300694. Details of each certification follow.

• CCN 525425 Skilled nursing facility · Active · Details

Skilled nursing facility certification: CCN 525425

Legal name

DIVINE REHABILITATION AND NURSING AT FENNIMORE LLC

Certification status

Active

Provider type (POS)

Nursing home – SNF/NF dual certification

Participating since

May 14, 1989

Last certification

Aug 1, 2024

Beds

50

Ownership / control type

Limited Liability Corporation

Multi-facility organization

Dove Healthcare

Organization structure

LLCProprietary

Incorporated

Dec 6, 2018 in WI

Enrollment address

1850 11TH St
Fennimore, WI 53809-1612

Nursing home name

DOVE HEALTHCARE - FENNIMORE

Affiliated entity

DOVE HEALTHCARE

Listed as

Dove Healthcare - FennimoreCCN 525425 · All quality measures

Overall star rating

2 of 5

Health inspections

2 of 5

Staffing

4 of 5

Quality measures

3 of 5

Type

Medicare and Medicaid

Ownership

For profit - Limited Liability company

Certified

May 14, 1989

Medicare certification status

ActiveFrom the Provider of Services file

Certified beds

5039.8 residents per day on average

Chain

Dove Healthcare11 facilities in the chain

Penalties (3 years)

5Fines totaling $104,515

Processed by Care Compare on Aug 1, 2026.

All disclosed owners & managing parties 3

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

Facilities with the same owner 2

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

• Divine Rehabilitation and Nursing at Lodi LLC

  • Skilled Nursing Facility
  • Lodi, WI
  • NPI 1730643123

  Wisconsin 3 Holdco LLC

  CMS ownership
• Divine Rehabilitation and Nursing at St Croix LLC

  • Skilled Nursing Facility
  • Saint Croix Falls, WI
  • NPI 1730643107

  Wisconsin 3 Holdco LLC

  CMS ownership

Affiliated clinicians 1

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

• Eric G Slane, MD

  • Family Medicine Physician
  • Lancaster, WI
  • NPI 1457362238

  Nursing home

  Care Compare affiliation

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

{
    "created_epoch": "1548806400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1736812800000",
    "number": "1306300694",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1632 61ST ST",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112042109",
            "telephone_number": "608-448-6200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1850 11TH ST",
            "city": "FENNIMORE",
            "state": "WI",
            "postal_code": "538091612",
            "telephone_number": "608-822-6100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DIVINE REHABILITATION AND NURSING AT FENNIMORE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-01-30",
        "last_updated": "2025-01-14",
        "certification_date": "2025-01-14",
        "status": "A",
        "authorized_official_last_name": "MARKOVITS",
        "authorized_official_first_name": "ISAAK",
        "authorized_official_title_or_position": "MANAGING MEMBER",
        "authorized_official_telephone_number": "718-753-0250"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "20150500",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Alicia Cleven, NP
• Amy Cooley, PTA
• Hannah Marie Cornell, PTA
• McKenzie Croft
• Sharon L Croft, RN
• Courtney Draude, M.A.,CCC-SLP
• Fennimore Area Rescue Squad Inc
• Fennimore Community Schools
• Fennimore Dental, LLC
• Fennimore Healing Arts, LLC

• Skilled Nursing Facility in Fennimore, WI
• Providers in Fennimore, WI by specialty
• Skilled Nursing Facility in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 14, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.