St. Coletta of Wisconsin

Primary specialty

Intellectual Disabilities Intermediate Care FacilityTaxonomy code 315P00000X

License

1109 Issued in WI

Legal business name

ST. COLETTA OF WISCONSIN

Practice address

W4955 US Highway 18
Jefferson, WI 53549-9702

Phone

(920) 674-4330

Fax

(920) 674-8422

NPI assigned

May 1, 2007

Organization subpart

No

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

Authorized official

Name

Mr. John Heindel

Title

Vice President Financial Services

Phone

(920) 674-8287

Specialties & licenses 1

Addresses

Other identifiers 1

Tax ID family

St Coletta of Wisconsin2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• St. Coletta of Wisconsin, Inc.

  • Adult Day Care Clinic/Center
  • Jefferson, WI
  • NPI 1295113587
  NPD tax ID

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

{
    "created_epoch": "1177977600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1871714543",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "W4955 US HIGHWAY 18",
            "city": "JEFFERSON",
            "state": "WI",
            "postal_code": "535499702",
            "telephone_number": "920-674-4330",
            "fax_number": "920-674-8422"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "W4955 US HIGHWAY 18",
            "city": "JEFFERSON",
            "state": "WI",
            "postal_code": "535499702",
            "telephone_number": "920-674-4330",
            "fax_number": "920-674-8422"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST. COLETTA OF WISCONSIN",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-01",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "HEINDEL",
        "authorized_official_first_name": "JOHN",
        "authorized_official_title_or_position": "VICE PRESIDENT FINANCIAL SERVICES",
        "authorized_official_telephone_number": "920-674-8287",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": "WI",
            "license": "1109",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PROVIDER NUMBER",
            "identifier": "20009700",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Carrie Louise Shimkus, LPC
• Samantha Rae Sims
• Lindsey Leigh Slatter
• Renee Spitzer, PHARMD
• Sport & Spine Clinic of Fort Atkinson Limited Partnership
• St. Coletta of Wisconsin, Inc.
• St. Marys Dean Ventures Inc.
• Sarah Emily Stewart, APNP
• Kathryn Marie Stingl, LCPC, CRC
• Andrea Marian Stotesbery

• Intellectual Disabilities Intermediate Care Facility in Jefferson, WI
• Providers in Jefferson, WI by specialty
• Intellectual Disabilities Intermediate Care Facility in Wisconsin

• 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.