NPIMap

Organization Active NPI

Benevolent Corporation Cedar Community

Doing business as Cedar Lake Health and Rehabilitation Center

  • Skilled Nursing Facility
  • West Bend, WI
National Provider Identifier
1811997695
Registry record updated Mar 15, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
0705 Issued in WI
Legal business name
BENEVOLENT CORPORATION CEDAR COMMUNITY
Doing business as
Cedar Lake Health and Rehabilitation Center
Practice address
5595 County Road Z
West Bend, WI 53095-9224
Phone
(262) 306-2100
Fax
(262) 306-2126
NPI assigned
Jul 22, 2005
Last updated
Mar 15, 2021By the provider in NPPES
Organization subpart
Yes
Parent organization
BENEVOLENT CORPORATION CEDAR COMMUNITYAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 15, 2021

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

Authorized official

Name
Joseph T Pichler
Title
Vice President of Finance
Phone
(262) 306-4212

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X 0705 WI Primary

Addresses

Primary practice location

5595 County Road Z
West Bend, WI 53095-9224

Mailing address

5595 County Road Z
West Bend, WI 53095-9224
Phone (262) 306-2100

Other identifiers 1

IdentifierTypeStateIssuer
20125800MedicaidWI

Other names 1

  • Cedar Lake Health and Rehabilitation Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20080204000012 WI Part B Supplier - Clinic/Group Practice 0749268662 3 other NPIs on this enrollment
Practice locations: West Bend, WI
O20080611000266 WI Part A Provider - Skilled Nursing Facility 0749268662 1 other NPI on this enrollment
Practice locations: West Bend, WI

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1811997695. Details of each certification follow.

Skilled nursing facility certification: CCN 525465

Legal name
BENEVOLENT CORPORATION CEDAR COMMUNITY
Doing business as
CEDAR LAKE HEALTH & REHABILITATION CENTER
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Jul 1, 1990
Last certification
Feb 19, 2025
Beds
75
Ownership / control type
Nonprofit Corporation
Organization structure
CorporationNon-profit
Incorporated
Apr 22, 1953 in WI
Enrollment address
5595 County Road Z
West Bend, WI 53095-9224
Nursing home name
CEDAR LAKE HEALTH AND REHAB CENTER

Other NPIs with the same Medicare PAC ID 1

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

Other NPIs on the same Medicare enrollment 4

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Care Compare: Nursing home

Medicare Care Compare
Listed as
Cedar Lake Health and Rehab CenterCCN 525465 · All quality measures
Overall star rating
5 of 5
Health inspections
4 of 5
Staffing
5 of 5
Quality measures
4 of 5
Type
Medicare and Medicaid
Ownership
Non profit - Corporation
Certified
Jul 1, 1990
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
7553.7 residents per day on average

Processed by Care Compare on Aug 1, 2026.

National Provider Directory

National Provider Directory
Part of
Cedar Haven Rehab Agenc

Ownership & related parties

All disclosed owners & managing parties 16

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

NameRoleSinceShare
Jennifer Fullhart Individual Operational/Managerial Control Oct 3, 2022
Kelli Deruyter Individual Operational/Managerial Control Feb 1, 2024
Adp of the SNF Feb 1, 2024
Todd Miller Individual Operational/Managerial Control Nov 4, 2019
Christopher C Zwygart Individual Managing Control - Governing BodyBoard Member Jul 1, 2021
Sheri L Katzer Individual Managing Control - Governing BodySecretary Jan 1, 2025
Thomas S Ross Individual Managing Control - Governing BodyTreasurer Jul 1, 2018
Michael Wisnefske Individual Managing Control - Governing BodyBoard Member Jul 1, 2021
Nicole E Pretre Individual Corporate OfficerChief Executive Officer May 15, 2021
James Karls Individual Corporate DirectorChief Financial Officer Nov 11, 2024
Patrick O' Connor Individual Managing Control - Governing BodyBoard Member Jan 1, 2025
Joseph a Carlson Individual Managing Control - Governing BodyBoard President Jul 1, 2021
Sarah Malchow Individual Operational/Managerial Control May 13, 2019
Alok Goyal Individual Operational/Managerial Control Jan 1, 2025
Adp of the SNF Jan 1, 2025
Jonathan E Kirkegaard Individual Managing Control - Governing BodyBoard Member Jan 1, 2025
Tracy Blaubach Individual Operational/Managerial Control Mar 27, 2018
Charles Omeara Individual Managing Control - Governing BodyVice President Jan 1, 2025

Owners & managing parties with NPI records 1

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

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Affiliated clinicians 13

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 13

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1121990400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1615766400000",
    "number": "1811997695",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5595 COUNTY ROAD Z",
            "city": "WEST BEND",
            "state": "WI",
            "postal_code": "530959224",
            "telephone_number": "262-306-2100",
            "fax_number": "262-306-2126"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5595 COUNTY ROAD Z",
            "city": "WEST BEND",
            "state": "WI",
            "postal_code": "530959224",
            "telephone_number": "262-306-2100",
            "fax_number": "262-306-2126"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BENEVOLENT CORPORATION CEDAR COMMUNITY",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "BENEVOLENT CORPORATION CEDAR COMMUNITY",
        "enumeration_date": "2005-07-22",
        "last_updated": "2021-03-15",
        "certification_date": "2021-03-15",
        "status": "A",
        "authorized_official_last_name": "PICHLER",
        "authorized_official_first_name": "JOSEPH",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "VICE PRESIDENT OF FINANCE",
        "authorized_official_telephone_number": "262-306-4212"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "WI",
            "license": "0705",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "20125800",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Cedar Lake Health and Rehabilitation Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in West Bend, WI

Sources for this page

Verify at the official NPI Registry.