Organization Active NPI

Glenhaven, Inc.

  • Skilled Nursing Facility
  • Glenwood City, WI
National Provider Identifier
1700809126
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
0852 Issued in WI
Legal business name
GLENHAVEN, INC.
Practice address
612 E Oak St
Glenwood City, WI 54013-8520
Phone
(715) 265-4555
NPI assigned
Jul 26, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Rolf Donhowe
Title
Administrator
Phone
(715) 265-4555

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X 0852 WI Primary

Addresses

Primary practice location

612 E Oak St
Glenwood City, WI 54013-8520

Mailing address

612 E Oak St
Glenwood City, WI 54013-8520

Other identifiers 1

IdentifierTypeStateIssuer
20157600MedicaidWI

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120125000881 WI Part A Provider - Skilled Nursing Facility 8123295599 Practice locations: Glenwood City, WI

Skilled nursing facility certification: CCN 525602

Legal name
GLENHAVEN, INC.
Doing business as
GLENHAVEN REHABILITATION AND SKILLED NURSING
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Oct 1, 1996
Last certification
Dec 11, 2024
Beds
44
Ownership / control type
Nonprofit Corporation
Organization structure
CorporationNon-profit
Enrollment address
612 E Oak St
Glenwood City, WI 54013-8520
Nursing home name
GLENHAVEN
Affiliated entity
HEALTH DIMENSIONS GROUP

Care Compare: Nursing home

Medicare Care Compare
Listed as
GlenhavenCCN 525602
Overall star rating
3 of 5
Health inspections
2 of 5
Staffing
5 of 5
Quality measures
4 of 5
Type
Medicare and Medicaid
Ownership
Non profit - Corporation
Certified
Oct 1, 1996
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
4428.1 residents per day on average
Chain
Health Dimensions Group10 facilities in the chain

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
52D0688267Glenhaven Inc612 East Oak St, Glenwood City, WI 54013Certificate of waiverAug 31, 2026

National Provider Directory

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
Cyndy Tuttle Individual Corporate DirectorBoard Member Sep 4, 2018
Operational/Managerial Control Sep 4, 2018
John McCutchin Individual Corporate OfficerBoard Member Jun 20, 2011
Corporate DirectorBoard President Jun 1, 1991
Operational/Managerial Control Jun 20, 2011
Thomas Field Individual Operational/Managerial Control Nov 1, 2022
Adp of the SNF Nov 1, 2022
Samantha Moe Individual Corporate DirectorDirector of Finance Jul 31, 2017
Operational/Managerial Control Jul 31, 2017
Adp of the SNF Jul 31, 2017
Lesley Nelson Individual Corporate DirectorBoard Member Jun 15, 2010
Operational/Managerial Control Jun 15, 2010
Kevin H Larson Individual Corporate DirectorAdministrator Jul 11, 2024
Operational/Managerial Control Jul 11, 2024
Adp of the SNF Jul 11, 2024
Paul Ramey Individual Corporate DirectorBoard Member Apr 24, 2024
Operational/Managerial Control Apr 24, 2024
Glenhaven, Inc. Organization, Glenwood City, WI Medical provider/supplier 5% Or Greater Mortgage Interest Jan 1, 1966 100%
Operational/Managerial Control Jan 1, 1966
Adp of the SNF Jan 1, 1966

Owners & managing parties with NPI records 1

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

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": "1153872000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1700809126",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "612 E OAK ST",
            "city": "GLENWOOD CITY",
            "state": "WI",
            "postal_code": "540138520"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "612 E OAK ST",
            "city": "GLENWOOD CITY",
            "state": "WI",
            "postal_code": "540138520",
            "telephone_number": "715-265-4555"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GLENHAVEN, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-26",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "DONHOWE",
        "authorized_official_first_name": "ROLF",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "715-265-4555"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "WI",
            "license": "0852",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "20157600",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Glenwood City, WI

Sources for this page

Verify at the official NPI Registry.