Lutheran Homes of Oconomowoc Inc.

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

Legal business name

LUTHERAN HOMES OF OCONOMOWOC INC.

Practice address

1305 W Wisconsin Ave
Oconomowoc, WI 53066-2646

Phone

(262) 560-6964

Fax

(262) 567-7189

NPI assigned

Sep 22, 2005

Last updated

Dec 16, 2011By 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

Joan Birr

Title

Chief Financial Officer

Phone

(262) 560-6969

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 1508852708. Details of each certification follow.

• CCN 525560 Skilled nursing facility · Active · Details

Skilled nursing facility certification: CCN 525560

Legal name

LUTHERAN HOMES OF OCONOMOWOC INC.

Doing business as

SHOREHAVEN HEALTH AND REHABILITATION CENTER

Certification status

Active

Provider type (POS)

Nursing home – SNF/NF dual certification

Participating since

Feb 1, 1995

Last certification

Jun 11, 2025

Beds

88

Ownership / control type

Nonprofit Corporation

Organization structure

CorporationNon-profit

Incorporated

Jan 1, 1939 in WI

Enrollment address

1305 W Wisconsin Ave
Oconomowoc, WI 53066-2646

Nursing home name

SHOREHAVEN HLTH & REHAB CTR

Listed as

Shorehaven HLTH & Rehab CTRCCN 525560 · All quality measures

Overall star rating

5 of 5

Health inspections

4 of 5

Staffing

5 of 5

Quality measures

5 of 5

Type

Medicare and Medicaid

Ownership

Non profit - Corporation

Certified

Feb 1, 1995

Medicare certification status

ActiveFrom the Provider of Services file

Certified beds

8873.1 residents per day on average

Penalties (3 years)

1Fines totaling $0

Processed by Care Compare on Aug 1, 2026.

Tax ID family

Lutheran Homes of Oconomowoc2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

• Lutheran Homes of Oconomowoc

  dba Shorehaven Tower Assisted Living

  • Assisted Living Facility
  • Oconomowoc, WI
  • NPI 1730579772
  NPD tax ID

All disclosed owners & managing parties 20

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

Owners & managing parties with NPI records 1

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

• William R. Cooper, MD

  • Internal Medicine Physician
  • Oconomowoc, WI
  • NPI 1023078037

  Adp of the SNF, Operational/Managerial Control

  CMS ownership

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.

• William R. Cooper, MD

  • Internal Medicine Physician
  • Oconomowoc, WI
  • NPI 1023078037
  NPD (past)

Affiliated clinicians 2

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

• William R. Cooper, MD

  • Internal Medicine Physician
  • Oconomowoc, WI
  • NPI 1023078037

  Nursing home

  Care Compare affiliation
• Jesus Casas, M.D.

  • Internal Medicine Physician
  • Houston, TX
  • NPI 1902008196

  Nursing home

  Care Compare affiliation

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

{
    "created_epoch": "1127347200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1323993600000",
    "number": "1508852708",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 208",
            "city": "OCONOMOWOC",
            "state": "WI",
            "postal_code": "530660208",
            "telephone_number": "262-560-6964",
            "fax_number": "262-567-7189"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1305 W WISCONSIN AVE",
            "city": "OCONOMOWOC",
            "state": "WI",
            "postal_code": "530662646",
            "telephone_number": "262-560-6964",
            "fax_number": "262-567-7189"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LUTHERAN HOMES OF OCONOMOWOC INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-09-22",
        "last_updated": "2011-12-16",
        "status": "A",
        "authorized_official_last_name": "BIRR",
        "authorized_official_first_name": "JOAN",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "262-560-6969"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "20152300",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• William G. Longe, D.D.S.
• LTDK LLC
• Paula R Lukas, PHARMD
• Philip Lewis Lutgen, R.PH.
• Lutheran Homes of Oconomowoc (Shorehaven Tower Assisted Living)
• Nicholas Edward Mahoney
• Alicia Therese Malak, DDS
• Gabriela Almeida Maloney, DO
• Caley Deloris Mamerow, LPC
• Laura Jane Mamerow, RD

• Skilled Nursing Facility in Oconomowoc, WI
• Providers in Oconomowoc, 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 Dec 16, 2011; 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.