Active NPI
Glenhaven, Inc.
- Skilled Nursing Facility
- Glenwood City, WI
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Skilled Nursing Facility
- License
- 0852
- 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
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) | Code | License | State | Primary |
|---|---|---|---|---|
| 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
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 20157600 | Medicaid | WI |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in WI
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| 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
- Corporation
- 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
- Glenhaven
- Overall star rating
- Health inspections
- Staffing
- Quality measures
- Type
- Medicare and Medicaid
- Ownership
- Non profit - Corporation
- Certified
- Oct 1, 1996
- Medicare certification status
- Active
- Certified beds
- 44
- Chain
- Health Dimensions Group
Laboratory certificates & supplier records
Derived by NPIMapThese CMS records do not include an NPI. They are shown because their name and street address match this provider’s.
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 52D0688267 | Glenhaven Inc | Certificate of waiver | Aug 31, 2026 |
National Provider Directory
National Provider DirectoryOwnership & 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.
| Name | Role | Since | Share |
|---|---|---|---|
| Cyndy Tuttle | Corporate Director | Sep 4, 2018 | |
| Operational/Managerial Control | Sep 4, 2018 | ||
| John McCutchin | Corporate Officer | Jun 20, 2011 | |
| Corporate Director | Jun 1, 1991 | ||
| Operational/Managerial Control | Jun 20, 2011 | ||
| Thomas Field | Operational/Managerial Control | Nov 1, 2022 | |
| Adp of the SNF | Nov 1, 2022 | ||
| Samantha Moe | Corporate Director | Jul 31, 2017 | |
| Operational/Managerial Control | Jul 31, 2017 | ||
| Adp of the SNF | Jul 31, 2017 | ||
| Lesley Nelson | Corporate Director | Jun 15, 2010 | |
| Operational/Managerial Control | Jun 15, 2010 | ||
| Kevin H Larson | Corporate Director | Jul 11, 2024 | |
| Operational/Managerial Control | Jul 11, 2024 | ||
| Adp of the SNF | Jul 11, 2024 | ||
| Paul Ramey | Corporate Director | Apr 24, 2024 | |
| Operational/Managerial Control | Apr 24, 2024 | ||
| Glenhaven, Inc. | 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.
-
- Hospice and Palliative Medicine (Family Medicine) Physician
- Baldwin, WI
- NPI 1336105840
Adp of the SNF, Operational/Managerial Control
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
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.