NPIMap

Organization Active NPI

Fond Du Lac County

Doing business as Harbor Haven Health & Rehabilitation

  • Skilled Nursing Facility
  • Fond Du Lac, WI
National Provider Identifier
1659358323
Registry record updated Jul 16, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
2437 Issued in WI
Legal business name
FOND DU LAC COUNTY
Doing business as
Harbor Haven Health & Rehabilitation
Practice address
459 E 1St St
Fond Du Lac, WI 54935-4505
Phone
(920) 929-3543
Fax
(920) 929-7509
NPI assigned
Dec 23, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 16, 2019

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

Authorized official

Name
Mark Radmer
Title
Administrator
Phone
(920) 929-3309

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X 2437 WI Primary

Addresses

Primary practice location

459 E 1St St
Fond Du Lac, WI 54935-4505

Mailing address

459 E 1St St
Fond Du Lac, WI 54935-4505
Phone (920) 929-3543

Other identifiers 1

IdentifierTypeStateIssuer
20130800MedicaidWI

Other names 1

  • Harbor Haven Health & Rehabilitation Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070618000352 WI Part A Provider - Skilled Nursing Facility 2668376245 Practice locations: Fond Du Lac, WI

Skilled nursing facility certification: CCN 525534

Legal name
FOND DU LAC COUNTY
Doing business as
HARBOR HAVEN HEALTH & REHABILITATION
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Jun 1, 1994
Last certification
Apr 23, 2025
Beds
85
Ownership / control type
County
Organization structure
GovernmentNon-profit
Enrollment address
459 E 1St St
Fond Du Lac, WI 54935-4505
Nursing home name
HARBOR HAVEN HEALTH & REHABILITATION

Other NPIs with the same Medicare PAC ID 3

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Care Compare: Nursing home

Medicare Care Compare
Listed as
Harbor Haven Health & RehabilitationCCN 525534 · All quality measures
Overall star rating
5 of 5
Health inspections
5 of 5
Staffing
5 of 5
Quality measures
4 of 5
Type
Medicare and Medicaid
Ownership
Government - County
Certified
Jun 1, 1994
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
8578.8 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
52D0894337Harbor Haven Health & Rehabilitation459 E First St, Fond Du Lac, WI 54935Certificate of waiverNov 13, 2026

National Provider Directory

National Provider Directory
Tax ID family
Fond Du Lac County DSS Personal Care14 organizations share this tax ID, including this one

Other organizations with this tax ID 13

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

View all 13

Ownership & related parties

All disclosed owners & managing parties 4

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

NameRoleSinceShare
Mary Beth Anton Individual Operational/Managerial Control Jul 25, 2022
Adp of the SNF Jul 25, 2022
Fond Du Lac County Organization, Fond Du Lac, WI 5% Or Greater Direct Ownership Interest Jan 1, 1972 100%
Operational/Managerial Control Jan 1, 1972
Trustee of the SNF Jan 1, 1972
Adp of the SNF Jan 1, 1972
Lisa R Weber Individual Operational/Managerial Control Mar 1, 2017
Adp of the SNF Mar 1, 2017
Mark Radmer Individual Operational/Managerial Control Dec 28, 2009
Adp of the SNF Apr 9, 2025

Owners & managing parties with NPI records 4

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

  • Fond Du Lac County

    dba Department of Human Services Clinical Services

    • Mental Health Clinic/Center (Including Community Mental Health Center)
    • Fond Du Lac, WI
    • NPI 1053458935

    5% Or Greater Direct Ownership Interest, Adp of the SNF, Operational/Managerial Control, Trustee of the SNF

    CMS ownership
  • Fond Du Lac County
    • Psychiatric Hospital
    • Fond Du Lac, WI
    • NPI 1235252024

    5% Or Greater Direct Ownership Interest, Adp of the SNF, Operational/Managerial Control, Trustee of the SNF

    CMS ownership
  • Fond Du Lac County
    • Public Health or Welfare Agency
    • Fond Du Lac, WI
    • NPI 1285606178

    5% Or Greater Direct Ownership Interest, Adp of the SNF, Operational/Managerial Control, Trustee of the SNF

    CMS ownership
  • Lisa R Weber, MD
    • Family Medicine Physician
    • Fond Du Lac, WI
    • NPI 1881883635

    Adp of the SNF, Operational/Managerial Control

    CMS ownership

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Fond Du Lac CountyFond Du Lac, WI, CCN 524025 Hospital Other Mar 18, 2022

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Practitioners & affiliated clinicians

Affiliated clinicians 2

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": "1135296000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1563235200000",
    "number": "1659358323",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "459 E 1ST ST",
            "city": "FOND DU LAC",
            "state": "WI",
            "postal_code": "549354505",
            "telephone_number": "920-929-3543",
            "fax_number": "920-929-7509"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "459 E 1ST ST",
            "city": "FOND DU LAC",
            "state": "WI",
            "postal_code": "549354505",
            "telephone_number": "920-929-3543",
            "fax_number": "920-929-7509"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FOND DU LAC COUNTY",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-12-23",
        "last_updated": "2019-07-16",
        "status": "A",
        "authorized_official_last_name": "RADMER",
        "authorized_official_first_name": "MARK",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "920-929-3309"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "WI",
            "license": "2437",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "20130800",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Harbor Haven Health & Rehabilitation",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Harbor Haven Health & Rehabilitation",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fond Du Lac, WI

Sources for this page

Verify at the official NPI Registry.