Powerback Rehabilitation LLC
Organization Active NPI Rehabilitation Clinic/Center · Walworth, WI
NPI 1649693128 · NPPES record last updated Mar 6, 2023
Key facts
- NPI
- 1649693128
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Rehabilitation Clinic/Center 261QR0400X
- Legal business name
- POWERBACK REHABILITATION LLC
- Practice address
- N2270 State Road 67
Walworth, WI 53184-5633 - Phone
- (262) 222-5857
- NPI assigned
- Feb 4, 2014
- Organization subpart
- No
Authorized official
- Name
- Carl Anthony Shrom
- Title
- Ceo
- Phone
- (215) 896-0422
Corporate family (same tax ID) 6
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WI
All facility ownership & control disclosures 25
| Facility | Type | Role | Since |
|---|---|---|---|
| Sharon Care Center |
Skilled nursing facility | Adp of the SNF | Oct 1, 2024 |
| The Earlwood |
Skilled nursing facility | Adp of the SNF | Feb 1, 2020 |
| Montebello Care Center |
Skilled nursing facility | Adp of the SNF | Jun 1, 2020 |
| Fountain View Subacute and Nursing Center |
Skilled nursing facility | Adp of the SNF | Jun 1, 2020 |
| Rio Hondo Subacute and Nursing Center |
Skilled nursing facility | Adp of the SNF | Jun 1, 2020 |
| The Heights of Summerlin |
Skilled nursing facility | Adp of the SNF | Feb 1, 2020 |
| Redstone Highlands |
Skilled nursing facility | Operational/Managerial Control Adp of the SNF |
Jul 25, 2022 Jul 7, 2025 |
| Bear Canyon Rehabilitation Center |
Skilled nursing facility | Adp of the SNF | Oct 25, 2021 |
| Clipboard Health |
Skilled nursing facility | Adp of the SNF | Jul 1, 2024 |
| Powerback Rehabilitation |
Skilled nursing facility | Adp of the SNF | Jul 1, 2024 |
| Lopatcong Center |
Skilled nursing facility | Adp of the SNF | Feb 1, 2023 |
| North Cape Center |
Skilled nursing facility | Adp of the SNF | Feb 1, 2020 |
| Norriton Square Nursing and Rehabilitation Center |
Skilled nursing facility | Adp of the SNF | Jan 1, 2019 |
| Mount Olive Center |
Skilled nursing facility | Adp of the SNF | Jan 23, 2025 |
| Pembroke Center |
Skilled nursing facility | Operational/Managerial Control Adp of the SNF |
Jan 1, 2019 Feb 4, 2025 |
| Abbotts Creek Center |
Skilled nursing facility | Other (100%) | Dec 1, 2023 |
| Bel-Aire Center |
Skilled nursing facility | Adp of the SNF | Jan 1, 2019 |
| Lake Ridge Center |
Skilled nursing facility | Adp of the SNF | Jan 1, 2019 |
| Gasconade Manor Nursing Home |
Skilled nursing facility | Operational/Managerial Control Adp of the SNF |
Dec 1, 2014 Apr 15, 2025 |
| Maple Glen Center |
Skilled nursing facility | Adp of the SNF | Jan 22, 2025 |
| Troy Hills Center |
Skilled nursing facility | Adp of the SNF | Feb 1, 2019 |
| Cashmere Post Acute |
Skilled nursing facility | Operational/Managerial Control Adp of the SNF |
Jan 1, 2019 Nov 10, 2025 |
| The Pavilion at Crescent Lake |
Skilled nursing facility | Adp of the SNF | May 1, 2018 |
| The Pavilion at Jacksonville |
Skilled nursing facility | Adp of the SNF | May 28, 2021 |
| Respiratory and Rehab Center of Ri |
Skilled nursing facility | Adp of the SNF | May 23, 2025 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20140304000612 | WI | Part a Provider - Outpatient Physical Therapy/Occupational Therapy/Speech Pathology Services | 2365359932 | Practice locations: Kenosha, WI; Walworth, WI; Milton, WI; Beloit, WI |
National Provider Directory
- Tax ID family
- Genesis Rehab Serv
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Rehabilitation Clinic/Center | 261QR0400X | Yes |
Addresses
Primary practice location
N2270 State Road 67
Walworth, WI 53184-5633
Mailing address
101 E State St
C/O Amy Nunemaker
Kennett Square, PA 19348-3109
Phone (610) 925-4560
Other names
- Powerback Rehabilitation
Other providers in Walworth, WI
- Bridget Grace Labus
- Lake Geneva Psychology, Inc.
- McCullough Pharmacy Inc
- Michael C. Nice
- Catie Fern Pontel
- Daniel William Rankin
- Lindsey E Tuntland
- Jennifer L Van Vleet
- Village of Walworth
- Walworth Elementary School
All providers in Walworth, WI · Rehabilitation Clinic/Center in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 6, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.