Active NPI
Cedar Crest, Inc.
- Skilled Nursing Facility
- Janesville, WI
National Provider Identifier
1831171610
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Skilled Nursing Facility
- License
- 2201
- Legal business name
- CEDAR CREST, INC.
- Practice address
- 1702 S River Rd
Janesville, WI 53546-5648 - Phone
- (608) 756-0344
- Fax
- (608) 756-9275
- NPI assigned
- Nov 16, 2005
- 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
- Mrs. Marion Wozniak
- Title
- President / Ceo
- Phone
- (608) 373-6301
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Skilled Nursing Facility | 314000000X | 2201 | WI | Primary |
Addresses
Primary practice location
1702 S River Rd
Janesville, WI 53546-5648
Mailing address
1702 S River Rd
Janesville, WI 53546-5648
Phone (608) 756-0344
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 20148600 | 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 |
|---|---|---|---|---|
| O20130212000151 | WI | Part A Provider - Skilled Nursing Facility | 2365696713 | Practice locations: Janesville, WI |
Skilled nursing facility certification: CCN 525649
- Legal name
- CEDAR CREST, INC.
- Certification status
- Active
- Provider type (POS)
- Nursing home – SNF/NF dual certification
- Participating since
- Jan 20, 1999
- Last certification
- Feb 12, 2025
- Beds
- 71
- Ownership / control type
- Church Related
- Organization structure
- Corporation
- Incorporated
- Apr 17, 1961 in WI
- Enrollment address
- 1702 S River Rd
Janesville, WI 53546-5648 - Nursing home name
- CEDAR CREST HEALTH CENTER
Care Compare: Nursing home
Medicare Care Compare- Listed as
- Cedar Crest Health Center
- Overall star rating
- Health inspections
- Staffing
- Quality measures
- Type
- Medicare and Medicaid
- Ownership
- Non profit - Church related
- Certified
- Jan 20, 1999
- Medicare certification status
- Active
- Certified beds
- 71
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 |
|---|---|---|---|
| 52D0392829 | Cedar Crest Health Center | Certificate of waiver | Aug 31, 2026 |
National Provider Directory
National Provider DirectoryLocations
1702 S River Rd
Janesville, WI 53546
Phone (608) 373-6322
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.
| Name | Role | Since | Share |
|---|---|---|---|
| David Tanck | Corporate Officer | Dec 5, 2016 | 100% |
| Operational/Managerial Control | Dec 5, 2016 | 100% | |
| Adp of the SNF | Dec 5, 2016 | ||
| Gerald Kelm | Corporate Director | Jun 30, 2012 | |
| Meredith Aarud | Corporate Officer | Jun 30, 2012 | |
| Adp of the SNF | Jun 30, 2012 | ||
| Sarfraz Sidhu | Operational/Managerial Control | Nov 17, 2022 | |
| Adp of the SNF | Nov 17, 2022 | ||
| Tari Miller | Corporate Director | Jun 30, 2011 | |
| Carol Hatch | Corporate Director | Jun 30, 2011 | |
| Christopher V Mulae | Corporate Officer | Jan 31, 2024 | |
| Adp of the SNF | Jan 31, 2024 | ||
| Thomas Lasse | Corporate Director | Jun 30, 2012 |
Owners & managing parties with NPI records 1
Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.
-
- Internal Medicine Physician
- Waukesha, WI
- NPI 1801946462
Adp of the SNF, Operational/Managerial Control
Practitioners & affiliated clinicians
Affiliated clinicians 13
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": "1132099200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1598054400000",
"number": "1831171610",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1702 S RIVER RD",
"city": "JANESVILLE",
"state": "WI",
"postal_code": "535465648",
"telephone_number": "608-756-0344",
"fax_number": "608-756-9275"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1702 S RIVER RD",
"city": "JANESVILLE",
"state": "WI",
"postal_code": "535465648",
"telephone_number": "608-756-0344",
"fax_number": "608-756-9275"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "CEDAR CREST, INC.",
"organizational_subpart": "NO",
"enumeration_date": "2005-11-16",
"last_updated": "2020-08-22",
"status": "A",
"authorized_official_last_name": "WOZNIAK",
"authorized_official_first_name": "MARION",
"authorized_official_title_or_position": "PRESIDENT / CEO",
"authorized_official_telephone_number": "608-373-6301",
"authorized_official_name_prefix": "Mrs."
},
"taxonomies": [
{
"code": "314000000X",
"taxonomy_group": "",
"desc": "Skilled Nursing Facility",
"state": "WI",
"license": "2201",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "20148600",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Janesville, 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.