NPIMap

Organization Active NPI

Northern Lights Services, Inc.

Doing business as Northern Lights Health Care Center

  • Skilled Nursing Facility
  • Washburn, WI
National Provider Identifier
1336198191
Registry record updated Dec 24, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
2624 Issued in WI
Legal business name
NORTHERN LIGHTS SERVICES, INC.
Doing business as
Northern Lights Health Care Center
Practice address
706 Bratley Dr
Washburn, WI 54891-1143
Phone
(715) 373-5621
Fax
(715) 373-5244
NPI assigned
May 9, 2006
Last updated
Dec 24, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 24, 2019

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

Authorized official

Name
Pauline Darling
Title
Ceo/Nha
Phone
(715) 373-6424

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X 2624 WI Primary

Addresses

Primary practice location

706 Bratley Dr
Washburn, WI 54891-1143

Mailing address

706 Bratley Dr
Washburn, WI 54891-1143
Phone (715) 373-5621

Other identifiers 1

IdentifierTypeStateIssuer
20105400MedicaidWI

Other names 1

  • NORTHERN LIGHTS 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
O20030131000034 WI Part A Provider - Skilled Nursing Facility 0648188334 Practice locations: Washburn, WI

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1336198191. Details of each certification follow.

Skilled nursing facility certification: CCN 525567

Legal name
NORTHERN LIGHTS SERVICES, INC.
Doing business as
NORTHERN LIGHTS HEALTHCARE
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Apr 25, 1995
Last certification
May 22, 2024
Beds
50
Ownership / control type
Nonprofit Corporation
Organization structure
CorporationNon-profit
Enrollment address
706 Bratley Dr
Washburn, WI 54891-1143
Nursing home name
NORTHERN LIGHTS HCC
Affiliated entity
HEALTH DIMENSIONS GROUP

Care Compare: Nursing home

Medicare Care Compare
Listed as
Northern Lights HCCCCN 525567 · 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
Non profit - Corporation
Certified
Apr 25, 1995
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
5044.7 residents per day on average
Chain
Health Dimensions Group10 facilities in the chain
Penalties (3 years)
1Fines totaling $10,364

Processed by Care Compare on Aug 1, 2026.

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 18

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

NameRoleSinceShare
Yvonne Cox Individual Corporate DirectorBoard Member Nov 1, 2024
Managing Control - Governing BodyDirector Nov 1, 2024
Sergei Nicholas Shvetzoff Individual Operational/Managerial Control Feb 1, 2024
Mark Ehlers Individual Corporate DirectorTreasurer Dec 22, 2021
Managing Control - Governing BodyTreasurer Dec 22, 2021
Health Dimensions Consulting Inc Organization, Hopkins, MN Corporation, Management services company, Consulting firm, For-profit Operational/Managerial Control Feb 1, 2024
Adp of the SNF Feb 18, 2025
Patricia Lynn Briscoe Individual Operational/Managerial Control Feb 1, 2024
Dick Bouton Individual Corporate DirectorBoard Member Jan 1, 2019
Managing Control - Governing BodyBoard Member Jan 1, 2019
Erin Leigh Shvetzoff Hennessey Individual Operational/Managerial Control Feb 1, 2024
David Lindsay Briscoe Individual Operational/Managerial Control Feb 1, 2024
Kim Ogle Individual Operational/Managerial Control Jun 1, 2024
Adp of the SNF Jun 1, 2024
Nolan Santikko Individual Operational/Managerial Control Mar 31, 2025
Adp of the SNF Mar 31, 2025
Amy Jacobson Individual Corporate DirectorSecretary May 1, 2023
Managing Control - Governing BodySecretary May 1, 2023
Ellen Avol Law Individual Corporate DirectorPresident Oct 17, 2018
Managing Control - Governing BodyPresident Oct 17, 2018
Organization, Washburn, WI Adp of the SNF Sep 14, 2017
Susan Aiken Individual Corporate DirectorBoard Member Jun 1, 2023
Managing Control - Governing BodyBoard Member Jun 1, 2023
Amber Rogotzke Individual Operational/Managerial Control Feb 1, 2024
Diana Strzok Individual Corporate DirectorDirector Oct 1, 2024
Managing Control - Governing BodyBoard Member Oct 1, 2024
Tami Lyn Shvetzoff Individual Operational/Managerial Control Feb 1, 2024
Sandra J Raspotnik Individual Corporate DirectorBoard Member Nov 1, 2023
Managing Control - Governing BodyBoard Member Nov 1, 2023

Owners & managing parties with NPI records 2

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

Facilities with the same owner 9

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

Practitioners & affiliated clinicians

Affiliated clinicians 5

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": "1147132800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1577145600000",
    "number": "1336198191",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "706 BRATLEY DR",
            "city": "WASHBURN",
            "state": "WI",
            "postal_code": "548911143",
            "telephone_number": "715-373-5621",
            "fax_number": "715-373-5244"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "706 BRATLEY DR",
            "city": "WASHBURN",
            "state": "WI",
            "postal_code": "548911143",
            "telephone_number": "715-373-5621",
            "fax_number": "715-373-5244"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHERN LIGHTS SERVICES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-09",
        "last_updated": "2019-12-24",
        "certification_date": "2019-12-24",
        "status": "A",
        "authorized_official_last_name": "DARLING",
        "authorized_official_first_name": "PAULINE",
        "authorized_official_title_or_position": "CEO/NHA",
        "authorized_official_telephone_number": "715-373-6424"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "WI",
            "license": "2624",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "20105400",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "NORTHERN LIGHTS HEALTH CARE CENTER",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "NORTHERN LIGHTS HEALTH CARE CENTER",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Washburn, WI

Sources for this page

Verify at the official NPI Registry.