NPIMap

Organization Active NPI

County of Walworth

Doing business as Lakeland Health Care Center

  • Skilled Nursing Facility
  • Elkhorn, WI
National Provider Identifier
1699767905
Registry record updated May 15, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
2416 Issued in WI
Legal business name
COUNTY OF WALWORTH
Doing business as
Lakeland Health Care Center
Practice address
1922 County Rd NN
Elkhorn, WI 53121-4335
Phone
(262) 741-3600
Fax
(262) 741-3682
NPI assigned
Aug 22, 2005
Last updated
May 15, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
WALWORTH COUNTYAs reported in NPPES

NPPES NPI Registry

Updated by the provider on May 15, 2024

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

Authorized official

Name
Mrs. Denise J Johnson
Title
Nha
Phone
(262) 741-3600

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X 2416 WI Primary

Addresses

Primary practice location

1922 County Rd NN
Elkhorn, WI 53121-4335

Mailing address

1922 County Road NN
Elkhorn, WI 53121-4454
Phone (262) 741-3600

Other identifiers 1

IdentifierTypeStateIssuer
20155000MedicaidWI

Other names 1

  • Lakeland Health Care Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20060801000462 WI Part A Provider - Skilled Nursing Facility 6002872835 Practice locations: Elkhorn, WI

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1699767905. Details of each certification follow.

Skilled nursing facility certification: CCN 525625

Legal name
COUNTY OF WALWORTH
Doing business as
LAKELAND HEALTH CARE CENTER
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Aug 1, 1997
Last certification
Aug 29, 2024
Beds
90
Ownership / control type
County
Organization structure
GovernmentNon-profit
Enrollment address
1922 County Road NN
Elkhorn, WI 53121-4454
Nursing home name
LAKELAND HEALTH CARE CTR

Other NPIs with the same Medicare PAC ID 1

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

  • County of Walworth

    dba Walworth County Department of Health and Human Services

    • Mental Health Clinic/Center (Including Community Mental Health Center)
    • Elkhorn, WI
    • NPI 1588733307

    6002872835

    Same PAC ID

Care Compare: Nursing home

Medicare Care Compare
Listed as
Lakeland Health Care CtrCCN 525625 · All quality measures
Overall star rating
3 of 5
Health inspections
2 of 5
Staffing
5 of 5
Quality measures
3 of 5
Type
Medicare and Medicaid
Ownership
Government - County
Certified
Aug 1, 1997
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
9080.9 residents per day on average
Abuse citation
Cited for abuse (Care Compare abuse icon)
Penalties (3 years)
1Fines totaling $84,168

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
52D0670647Lakeland Health Care Center1922 County Rd NN, Elkhorn, WI 53121Certificate of waiverAug 31, 2026

National Provider Directory

National Provider Directory
Tax ID family
Walworth County Dept of14 organizations share this tax ID, including this one
Part of
Walworth County Dept of

Other organizations with this tax ID 13

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

  • County of Walworth

    dba Walworth County Department of Health and Human Services

    • Community/Behavioral Health Agency
    • Elkhorn, WI
    • NPI 1114447455
    NPD tax ID
  • County of Walworth

    dba Walworth County Department of Health and Human Services

    • Case Management Agency
    • Elkhorn, WI
    • NPI 1205914967
    NPD tax ID
  • County of Walworth

    dba Walworth County Department of Health and Human Services

    • State or Local Public Health Clinic/Center
    • Elkhorn, WI
    • NPI 1265944573
    NPD tax ID
  • County of Walworth

    dba Walworth County Department of Health and Human Services

    • State or Local Public Health Clinic/Center
    • Elkhorn, WI
    • NPI 1548348311
    NPD tax ID
  • County of Walworth

    dba Walworth County Department of Health and Human Services

    • Mental Health Clinic/Center (Including Community Mental Health Center)
    • Elkhorn, WI
    • NPI 1588733307
    NPD tax ID
  • County of Walworth

    dba Walworth County Department of Health and Human Services

    • Community/Behavioral Health Agency
    • Elkhorn, WI
    • NPI 1710189196
    NPD tax ID
  • County of Walworth

    dba Walworth County Department of Health and Human Services

    • Rehabilitation Clinic/Center
    • Elkhorn, WI
    • NPI 1841443926
    NPD tax ID
  • County of Walworth

    dba Walworth County Department of Health and Human Services

    • Social Worker
    • Elkhorn, WI
    • NPI 1881931608
    NPD tax ID
  • County of Walworth

    dba Walworth County Department of Health and Human Services

    • Case Management Agency
    • Elkhorn, WI
    • NPI 1932287612
    NPD tax ID
  • County of Walworth

    dba Walworth County Department of Health and Human Services

    • Community/Behavioral Health Agency
    • Elkhorn, WI
    • NPI 1942364724
    NPD tax ID
  • County of Walworth

    dba Walworth County Department of Health and Human Services

    • Community/Behavioral Health Agency
    • Elkhorn, WI
    • NPI 1942532759
    NPD tax ID
  • County of Walworth

    dba Walworth County Department of Health and Human Services

    • Dental Assistant
    • Elkhorn, WI
    • NPI 1952618043
    NPD tax ID
View all 13

Ownership & related parties

All disclosed owners & managing parties 3

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

NameRoleSinceShare
Denise J Johnson Individual Corporate Director Feb 24, 2020 50%
Operational/Managerial Control Feb 24, 2020
Adp of the SNF Feb 24, 2020
County of Walworth Organization, Elkhorn, WI 5% Or Greater Direct Ownership Interest Jul 19, 2006 100%
Adp of the SNF Dec 31, 1973
Kenneth Monroe Individual Corporate OfficerBoard Member Jan 1, 2017 50%

Owners & managing parties with NPI records 1

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

  • County of Walworth

    dba Walworth County Department of Health and Human Services

    • Mental Health Clinic/Center (Including Community Mental Health Center)
    • Elkhorn, WI
    • NPI 1588733307

    5% Or Greater Direct Ownership Interest, Adp of the SNF

    CMS ownership

Practitioners & affiliated clinicians

Affiliated clinicians 3

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": "1124668800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1715731200000",
    "number": "1699767905",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1922 COUNTY ROAD NN",
            "city": "ELKHORN",
            "state": "WI",
            "postal_code": "531214454",
            "telephone_number": "262-741-3600",
            "fax_number": "262-741-3682"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1922 COUNTY RD NN",
            "city": "ELKHORN",
            "state": "WI",
            "postal_code": "531214335",
            "telephone_number": "262-741-3600",
            "fax_number": "262-741-3682"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COUNTY OF WALWORTH",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "WALWORTH COUNTY",
        "enumeration_date": "2005-08-22",
        "last_updated": "2024-05-15",
        "certification_date": "2024-05-15",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "DENISE",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "NHA",
        "authorized_official_telephone_number": "262-741-3600",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "WI",
            "license": "2416",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "20155000",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lakeland Health Care Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Elkhorn, WI

Sources for this page

Verify at the official NPI Registry.