NPIMap

Organization Active NPI

Fond Du Lac Lutheran Home, Inc.

  • Skilled Nursing Facility
  • Fond Du Lac, WI
National Provider Identifier
1649266404
Registry record updated Jul 10, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
0047 Issued in WI
Legal business name
FOND DU LAC LUTHERAN HOME, INC.
Practice address
244 N Macy St
Fond Du Lac, WI 54935-3362
Phone
(920) 951-9520
Fax
(920) 921-0819
NPI assigned
Sep 26, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 10, 2026

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

Authorized official

Name
Julie Anne Marks
Title
Cfo
Phone
(920) 261-0400

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Assisted Living Facility 310400000X
Skilled Nursing Facility 314000000X 0047 WI Primary

Addresses

Primary practice location

244 N Macy St
Fond Du Lac, WI 54935-3362

Mailing address

244 N Macy St
Fond Du Lac, WI 54935-3362
Phone (920) 951-9520

Other identifiers 1

IdentifierTypeStateIssuer
20129000MedicaidWI

Other names 4

  • Fond Du Lac Lutheran Home Doing business as
  • Lutheran Home and Health Services Doing business as
  • Tarfa Terrace Doing business as
  • Wellness and Rehab Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20111221000423 WI Part A Provider - Skilled Nursing Facility 3274709258 Practice locations: Fond Du Lac, WI

Skilled nursing facility certification: CCN 525655

Legal name
FOND DU LAC LUTHERAN HOME, INC.
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Jan 1, 2000
Last certification
Jul 10, 2024
Beds
85
Ownership / control type
Nonprofit Corporation
Organization structure
CorporationNon-profit
Incorporated
Mar 8, 1939 in WI
Enrollment address
244 N Macy St
Fond Du Lac, WI 54935-3362
Nursing home name
FOND DU LAC LUTHERAN HOME
Affiliated entity
ILLUMINUS

Care Compare: Nursing home

Medicare Care Compare
Listed as
Fond du Lac Lutheran HomeCCN 525655
Overall star rating
3 of 5
Health inspections
3 of 5
Staffing
2 of 5
Quality measures
2 of 5
Type
Medicare and Medicaid
Ownership
Non profit - Corporation
Certified
Jan 1, 2000
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
8554.9 residents per day on average
Chain
Illuminus5 facilities in the chain
Penalties (3 years)
1Fines totaling $9,113

Processed by Care Compare on Aug 1, 2026.

National Provider Directory

National Provider Directory
Tax ID family
Fond Du Lac Lutheran Home2 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.

Ownership & related parties

All disclosed owners & managing parties 8

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

NameRoleSinceShare
Matthew R Mauthe Individual Corporate OfficerCeo Aug 1, 2016
Operational/Managerial ControlChief Executive Officer Aug 1, 2016 100%
Adp of the SNF Aug 1, 2016
Illuminus Inc Organization, Watertown, WI Corporation, Management services company, Non-profit Operational/Managerial Control Aug 1, 2016
Adp of the SNF Nov 16, 2025
Terry Schleif Individual Corporate DirectorBoard Chair Jan 1, 2016
Lisa R Weber Individual Operational/Managerial Control Jan 1, 2014
Adp of the SNF Jan 1, 2014
Stanley Kaymen Individual Operational/Managerial Control Jan 13, 2023
Adp of the SNF Mar 3, 2026
Kim Suhs Individual Corporate DirectorVice Board Chair Jan 1, 2015
Julie Marks Individual Corporate OfficerCfo Sep 16, 2025
Corporate DirectorBoard Member Sep 16, 2025
Operational/Managerial Control Sep 16, 2025
Adp of the SNF Sep 16, 2025
Lutheran Homes and Health Services, Inc. Organization, Fond Du Lac, WI Corporation, Holding company, Non-profit 5% Or Greater Direct Ownership Interest Sep 19, 2000 100%
Operational/Managerial Control Feb 9, 2005

Owners & managing parties with NPI records 1

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

Facilities with the same owner 10

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

Practitioners & affiliated clinicians

Affiliated clinicians 1

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": "1127692800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1783641600000",
    "number": "1649266404",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "244 N MACY ST",
            "city": "FOND DU LAC",
            "state": "WI",
            "postal_code": "549353362",
            "telephone_number": "920-951-9520",
            "fax_number": "920-921-0819"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "244 N MACY ST",
            "city": "FOND DU LAC",
            "state": "WI",
            "postal_code": "549353362",
            "telephone_number": "920-951-9520",
            "fax_number": "920-921-0819"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FOND DU LAC LUTHERAN HOME, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-09-26",
        "last_updated": "2026-07-10",
        "certification_date": "2026-07-10",
        "status": "A",
        "authorized_official_last_name": "MARKS",
        "authorized_official_first_name": "JULIE",
        "authorized_official_middle_name": "ANNE",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "920-261-0400"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "WI",
            "license": "0047",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "20129000",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Fond Du Lac Lutheran Home",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Lutheran Home and Health Services",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Tarfa Terrace",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Wellness and Rehab Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fond Du Lac, WI

Sources for this page

Verify at the official NPI Registry.