NPIMap

Organization Active NPI

River Hawk Healthcare LLC

  • Skilled Nursing Facility
  • Wausau, WI
National Provider Identifier
1720819790
Registry record updated Aug 12, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
RIVER HAWK HEALTHCARE LLC
Practice address
1821 N 4TH Ave
Wausau, WI 54401-1910
Phone
(715) 675-9451
NPI assigned
Aug 12, 2024
Last updated
Aug 12, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 12, 2024

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

Authorized official

Name
Soon Burnam
Title
Treasurer
Phone
(949) 540-1249

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X NU Primary

Addresses

Primary practice location

1821 N 4TH Ave
Wausau, WI 54401-1910

Mailing address

1821 N 4TH Ave
Wausau, WI 54401-1910

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20250404002562 WI Part A Provider - Skilled Nursing Facility 2769906320 Practice locations: Wausau, WI

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1720819790. Details of each certification follow.

Skilled nursing facility certification: CCN 525503

Legal name
RIVER HAWK HEALTHCARE LLC
Doing business as
WOOD AVEN HEALTH AND REHABILITATION
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Jan 1, 1993
Last certification
Jan 8, 2025
Beds
82
Ownership / control type
Limited Liability Corporation
Multi-facility organization
Gateway Wisconsin
Organization structure
LLCProprietary
Incorporated
Jul 25, 2024 in NV
Enrollment address
1821 N 4TH Ave
Wausau, WI 54401-1910
Nursing home name
WOOD AVEN HEALTH AND REHABILITATION
Affiliated entity
THE ENSIGN GROUP

Care Compare: Nursing home

Medicare Care Compare
Listed as
Wood Aven Health and RehabilitationCCN 525503 · All quality measures
Overall star rating
3 of 5
Health inspections
3 of 5
Staffing
4 of 5
Quality measures
4 of 5
Type
Medicare and Medicaid
Ownership
For profit - Limited Liability company
Certified
Jan 1, 1993
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
8271.3 residents per day on average
Chain
The Ensign Group342 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
52D0395284Wood Aven Health and Rehabilitation1821 North 4TH Avenue, Wausau, WI 54401Certificate of waiverFeb 9, 2028

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
The Ensign Group Inc Organization, San Juan Capistrano, CA Corporation 5% Or Greater Indirect Ownership Interest Jul 25, 2024 100%
Ami Sato Individual Corporate OfficerTreasurer of River Hawk Healthcare Sep 9, 2024
David Jorgensen Individual Corporate OfficerGateway HC Pres, River Hawk Manager Jul 25, 2024
Gateway Healthcare LLC Organization, San Juan Capistrano, CA LLC, Owned by another organization or individual 5% Or Greater Direct Ownership Interest Jul 25, 2024 100%
Jared Spaulding Individual Operational/Managerial Control Nov 27, 2024
Managing Control - Governing BodyAdministrator Nov 27, 2024
Adp of the SNF Mar 14, 2025
Amy Brauer Individual Corporate OfficerPresident of River Hawk Healthcare Jul 25, 2024
Soon Burnam Individual Corporate OfficerSecretary of River Hawk Healthcare Jul 25, 2024
Steven Nichols Individual Operational/Managerial Control Nov 1, 2024
Managing Control - Governing BodyMedical Director Nov 1, 2024
Adp of the SNF Nov 1, 2024

Owners & managing parties with NPI records 1

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

  • Steven D Nichols, MD
    • Family Medicine Physician
    • Wausau, WI
    • NPI 1518991199

    Adp of the SNF, Managing Control - Governing Body, Operational/Managerial Control

    CMS ownership

Facilities with the same owner 18

Facilities that share an organizational owner with 5% or greater ownership or operational control.

View all 18

Practitioners & affiliated clinicians

Affiliated clinicians 1

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": "1723420800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1723420800000",
    "number": "1720819790",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1821 N 4TH AVE",
            "city": "WAUSAU",
            "state": "WI",
            "postal_code": "544011910"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1821 N 4TH AVE",
            "city": "WAUSAU",
            "state": "WI",
            "postal_code": "544011910",
            "telephone_number": "715-675-9451"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RIVER HAWK HEALTHCARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-08-12",
        "last_updated": "2024-08-12",
        "certification_date": "2024-08-12",
        "status": "A",
        "authorized_official_last_name": "BURNAM",
        "authorized_official_first_name": "SOON",
        "authorized_official_title_or_position": "TREASURER",
        "authorized_official_telephone_number": "949-540-1249"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wausau, WI

Sources for this page

Verify at the official NPI Registry.