NPIMap

Organization Active NPI

Midway Manor Corp.

  • Skilled Nursing Facility
  • Kenosha, WI
National Provider Identifier
1801006978
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
2823 Issued in WI
Legal business name
MIDWAY MANOR CORP.
Practice address
1519 60TH St
Kenosha, WI 53140-3954
Phone
(262) 656-7500
NPI assigned
May 23, 2007
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
David Egan
Title
Administrator
Phone
(262) 656-7500

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X 2823 WI Primary

Addresses

Primary practice location

1519 60TH St
Kenosha, WI 53140-3954

Mailing address

1519 60TH St
Kenosha, WI 53140-3954
Phone (262) 656-7500

Other identifiers 1

IdentifierTypeStateIssuer
20117200MedicaidWI

Other names 1

  • Clairidge House Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120306000256 WI Part A Provider - Skilled Nursing Facility 6103085477 Practice locations: Kenosha, WI

Skilled nursing facility certification: CCN 525431

Legal name
MIDWAY MANOR CORP
Doing business as
CLAIRIDGE HOUSE
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Aug 1, 1989
Last certification
Oct 18, 2024
Beds
87
Ownership / control type
Corporation
Organization structure
CorporationProprietary
Incorporated
May 2, 1973 in WI
Enrollment address
1519 60TH St
Kenosha, WI 53140-3954
Nursing home name
CLAIRIDGE HOUSE
Affiliated entity
REAL PROPERTY HEALTH FACILITIES

Care Compare: Nursing home

Medicare Care Compare
Listed as
Clairidge HouseCCN 525431
Overall star rating
1 of 5
Health inspections
2 of 5
Staffing
4 of 5
Quality measures
1 of 5
Type
Medicare and Medicaid
Ownership
For profit - Corporation
Certified
Aug 1, 1989
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
8737.8 residents per day on average
Chain
Real Property Health Facilities9 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
52D0721952Clairidge House1519 60TH Street, Kenosha, WI 53140Certificate of waiverAug 31, 2026

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 7

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

NameRoleSinceShare
Dawn M Marsh Individual Corporate OfficerVP Apr 15, 1994 15%
Albert V Haworth Individual Corporate OfficerPresident/Ceo May 1, 2021 15%
Operational/Managerial ControlPresident/Ceo May 1, 2021 5%
Real Property Health Facilities Corp Organization, Las Vegas, NV Corporation Operational/Managerial Control Aug 1, 1989 100%
Christina J Penn Individual 5% Or Greater Indirect Ownership Interest Jun 1, 2015 100%
Other Jun 1, 2015 100%
Chad Smyth Individual Operational/Managerial ControlRegional Director Apr 16, 2020 20%
Christina Jayne Penn Management Trust Organization, Las Vegas, NV 5% Or Greater Direct Ownership Interest Nov 1, 2010 100%
David M Egan Individual W-2 Managing EmployeeAdministrator Sep 16, 2015 50%

Facilities with the same owner 8

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

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

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": "1179878400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1801006978",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1519 60TH ST",
            "city": "KENOSHA",
            "state": "WI",
            "postal_code": "531403954",
            "telephone_number": "262-656-7500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1519 60TH ST",
            "city": "KENOSHA",
            "state": "WI",
            "postal_code": "531403954",
            "telephone_number": "262-656-7500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MIDWAY MANOR CORP.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-23",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "EGAN",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "262-656-7500"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "WI",
            "license": "2823",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "20117200",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Clairidge House",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Kenosha, WI

Sources for this page

Verify at the official NPI Registry.