NPIMap

Organization Active NPI

Oneida Nation

Doing business as Anna John Resident Centered Care Community

  • Skilled Nursing Facility
  • Oneida, WI
National Provider Identifier
1407916174
Registry record updated Dec 3, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
2553 Issued in WI
Legal business name
ONEIDA NATION
Doing business as
Anna John Resident Centered Care Community
Practice address
2901 S Overland Rd
Oneida, WI 54155-8959
Phone
(920) 869-2797
NPI assigned
Dec 11, 2006
Last updated
Dec 3, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 3, 2020

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

Authorized official

Name
Debra Danforth, RN, BSN
Title
Operations Director
Phone
(920) 869-2711

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X 2553 WI Primary

Addresses

Primary practice location

2901 S Overland Rd
Oneida, WI 54155-8959

Mailing address

PO Box 365
Oneida, WI 54155-0365
Phone (920) 869-2797

Other identifiers 1

IdentifierTypeStateIssuer
20101600MedicaidWI

Other names 1

  • Anna John Resident Centered Care Community Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050907001088 WI Part A Provider - Skilled Nursing Facility 6800794074 Practice locations: Oneida, WI

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1407916174. Details of each certification follow.

Skilled nursing facility certification: CCN 525695

Legal name
ONEIDA NATION
Doing business as
ANNA JOHN RESIDENT CARE CENTERED COMMUNITY
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Oct 1, 2008
Last certification
Nov 6, 2024
Beds
48
Ownership / control type
Federal
Organization structure
GovernmentNon-profit
Incorporated
Jan 1, 1975 in WI
Enrollment address
2901 S Overland Rd
Oneida, WI 54155-8959
Nursing home name
ANNA JOHN RESIDENT CENTERED CARE COMMUNITY

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: Nursing home

Medicare Care Compare
Listed as
Anna John Resident Centered Care CommunityCCN 525695 · All quality measures
Overall star rating
5 of 5
Health inspections
4 of 5
Staffing
5 of 5
Quality measures
4 of 5
Type
Medicare and Medicaid
Ownership
Government - Federal
Certified
Oct 1, 2008
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
4841.6 residents per day on average

Processed by Care Compare on Aug 1, 2026.

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
52D0662027Anna John Resident Centered Care Community2901 Overland Rd, Oneida, WI 54155Certificate of waiverAug 31, 2026

National Provider Directory

National Provider Directory
Tax ID family
Oneida Nation12 organizations share this tax ID, including this one

Other organizations with this tax ID 11

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

Locations

2901 S Overland Rd
Oneida, WI 54155
Phone (920) 869-2797

Ownership & related parties

All disclosed owners & managing parties 5

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

NameRoleSinceShare
David L Larson Individual W-2 Managing EmployeeContinuum of Care Director Jun 15, 2016
Oneida Nation Organization, Oneida, WI 5% Or Greater Direct Ownership Interest Jan 1, 1975 100%
Debbie Danforth Individual W-2 Managing EmployeeComprehensive Health Division Mana Jun 29, 2007
Danielle L White Individual W-2 Managing EmployeeBilling Supervisor Dec 3, 2020
Jennie L Rosner Individual W-2 Managing EmployeeBilling Specialist Dec 3, 2020

Owners & managing parties with NPI records 1

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

Practitioners & affiliated clinicians

Practitioners 2

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.

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": "1165795200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1606953600000",
    "number": "1407916174",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 365",
            "city": "ONEIDA",
            "state": "WI",
            "postal_code": "541550365",
            "telephone_number": "920-869-2797"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2901 S OVERLAND RD",
            "city": "ONEIDA",
            "state": "WI",
            "postal_code": "541558959",
            "telephone_number": "920-869-2797"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ONEIDA NATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-11",
        "last_updated": "2020-12-03",
        "certification_date": "2020-12-03",
        "status": "A",
        "authorized_official_last_name": "DANFORTH",
        "authorized_official_first_name": "DEBRA",
        "authorized_official_title_or_position": "OPERATIONS DIRECTOR",
        "authorized_official_telephone_number": "920-869-2711",
        "authorized_official_credential": "RN, BSN"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "WI",
            "license": "2553",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "20101600",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Anna John Resident Centered Care Community",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Oneida, WI

Sources for this page

Verify at the official NPI Registry.