NPIMap

Organization Active NPI

Presbyterian Homes of Wisconsin, Inc.

Doing business as Avalon Square

  • Rehabilitation Clinic/Center
  • Waukesha, WI
National Provider Identifier
1336845551
Registry record updated Aug 4, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rehabilitation Clinic/CenterTaxonomy code 261QR0400X
Legal business name
PRESBYTERIAN HOMES OF WISCONSIN, INC.
Doing business as
Avalon Square
Presbyterian Homes and Services Rehabilitation
Practice address
222 Park PL
Waukesha, WI 53186-4858
Phone
(651) 631-6570
NPI assigned
Jan 31, 2023
Last updated
Aug 4, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 4, 2023

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

Authorized official

Name
Ashley Rue
Title
Director of Rehab
Phone
(651) 631-6415

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Rehabilitation Clinic/Center 261QR0400X NU Primary
Physical Therapist 225100000X NU
Occupational Therapist 225X00000X NU
Speech-Language Pathologist 235Z00000X NU

Addresses

Primary practice location

222 Park PL
Waukesha, WI 53186-4858

Mailing address

2845 Hamline Ave N
Roseville, MN 55113-7127
Phone (651) 631-6415

Other names 2

  • Avalon Square Doing business as
  • Presbyterian Homes and Services Rehabilitation Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20230317002328 WI Part B Supplier - Physical/Occupational Therapy Group in Private Practice 7618341439 Receives reassigned benefits from 20 practitioners
5 other NPIs on this enrollment
Practice locations: Waukesha, WI; Menomonee Falls, WI; Pewaukee, WI; Muskego, WI; Germantown, WI; Oconomowoc, WI
O20230629000900 WI Part A Provider - Outpatient Physical Therapy/Occupational Therapy/Speech Pathology Services 7618341439 Practice locations: Waukesha, WI

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1336845551. Details of each certification follow.

  • CCN 526617 Outpatient physical therapy / speech pathology · Active · Name & address match · Details

Outpatient physical therapy / speech pathology certification: CCN 526617

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
PRESBYTERIAN HOMES AND SERVICES REHABILITATION
Certification status
Active
Provider type (POS)
Outpatient physical therapy / speech pathology
Participating since
May 10, 2024
Last certification
May 10, 2024
Ownership / control type
Voluntary Non-Profit Other Than Church
Facility address
222 Park Place
Waukesha, WI 53186

Other NPIs on the same Medicare enrollment 5

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

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
52D1006718Presbyterian Homes and Services222 Park Place, Waukesha, WI 53186Certificate of waiverNov 25, 2026

National Provider Directory

National Provider Directory
Tax ID family
Presbyterian Homes and Services Rehabilitation7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

Organizations that report the same tax identification number in the National Provider Directory.

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 43

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.

View all 43

NPI Registry JSON

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

{
    "created_epoch": "1675123200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1691107200000",
    "number": "1336845551",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2845 HAMLINE AVE N",
            "city": "ROSEVILLE",
            "state": "MN",
            "postal_code": "551137127",
            "telephone_number": "651-631-6415"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "222 PARK PL",
            "city": "WAUKESHA",
            "state": "WI",
            "postal_code": "531864858",
            "telephone_number": "651-631-6570"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRESBYTERIAN HOMES OF WISCONSIN, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-01-31",
        "last_updated": "2023-08-04",
        "certification_date": "2023-08-04",
        "status": "A",
        "authorized_official_last_name": "RUE",
        "authorized_official_first_name": "ASHLEY",
        "authorized_official_title_or_position": "DIRECTOR OF REHAB",
        "authorized_official_telephone_number": "651-631-6415"
    },
    "taxonomies": [
        {
            "code": "261QR0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Avalon Square",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Presbyterian Homes and Services Rehabilitation",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Waukesha, WI

Sources for this page

Verify at the official NPI Registry.