NPIMap

Organization Active NPI

Four Winds Manor, Inc.

Doing business as Four Winds Manor and Lodge, Inc.

  • Skilled Nursing Facility
  • Verona, WI
National Provider Identifier
1902895592
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
1002 Issued in WI
Legal business name
FOUR WINDS MANOR, INC.
Doing business as
Four Winds Manor and Lodge, Inc.
Practice address
303 S Jefferson St
Verona, WI 53593-1415
Phone
(608) 845-6465
Fax
(608) 848-8315
NPI assigned
Oct 17, 2005
Last updated
Aug 22, 2020By the provider in NPPES
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
Mrs. Juanita Rose Retrum
Title
Office Manager
Phone
(608) 845-6465

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X 1002 WI Primary

Addresses

Primary practice location

303 S Jefferson St
Verona, WI 53593-1415

Mailing address

303 S Jefferson St
Verona, WI 53593-1415
Phone (608) 845-6465

Other identifiers 1

IdentifierTypeStateIssuer
20154000MedicaidWI

Other names 1

  • Four Winds Manor and Lodge, Inc. Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120124000768 WI Part A Provider - Skilled Nursing Facility 7113194697 Practice locations: Verona, WI

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1902895592. Details of each certification follow.

Skilled nursing facility certification: CCN 525656

Legal name
FOUR WINDS MANOR, INC.
Doing business as
LAKE RIDGE BANK
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Jul 1, 2000
Last certification
Aug 6, 2024
Beds
44
Ownership / control type
Corporation
Organization structure
CorporationProprietary
Incorporated
Jul 28, 1961 in WI
Enrollment address
303 S Jefferson St
Verona, WI 53593-1415
Nursing home name
FOUR WINDS MANOR

Care Compare: Nursing home

Medicare Care Compare
Listed as
Four Winds ManorCCN 525656 · All quality measures
Overall star rating
2 of 5
Health inspections
2 of 5
Staffing
4 of 5
Quality measures
3 of 5
Type
Medicare and Medicaid
Ownership
For profit - Corporation
Certified
Jul 1, 2000
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
4434.5 residents per day on average
Penalties (3 years)
1Fines totaling $0

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
52D0859710Four Winds Manor Inc303 S Jefferson St, Verona, WI 53593Certificate 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
Wegner Cpas Organization, Madison, WI Operational/Managerial Control Jan 1, 2014
Adp of the SNF Nov 21, 2025
Wipfli LLP Organization, Milwaukee, WI Consulting firm Operational/Managerial Control Jan 1, 2014
Adp of the SNF Nov 21, 2025
Julia Rose Lubsen Individual Operational/Managerial Control Jun 1, 2019
Adp of the SNF Jun 1, 2019
Shari Kellogg Individual Operational/Managerial Control Sep 15, 2025
Adp of the SNF Sep 15, 2025
State Bank of Cross Plains Organization, Cross Plains, WI Financial institution 5% Or Greater Mortgage Interest Nov 17, 2015 100%
Rose G Riedmaier Individual Operational/Managerial Control Feb 17, 2025
Adp of the SNF Feb 17, 2025
Mary Howard Individual 5% Or Greater Direct Ownership InterestCeo/Nha Mar 30, 2014 100%
Corporate OfficerPres, VP, Sec, Treas, Ceo, Coo Mar 31, 2014 100%
Operational/Managerial Control Apr 23, 2003
Adp of the SNF Apr 23, 2003

Owners & managing parties with NPI records 1

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

Facilities with the same owner 65

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

View all 65

Practitioners & affiliated clinicians

Affiliated clinicians 4

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": "1129507200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1902895592",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "303 S JEFFERSON ST",
            "city": "VERONA",
            "state": "WI",
            "postal_code": "535931415",
            "telephone_number": "608-845-6465",
            "fax_number": "608-848-8315"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "303 S JEFFERSON ST",
            "city": "VERONA",
            "state": "WI",
            "postal_code": "535931415",
            "telephone_number": "608-845-6465",
            "fax_number": "608-848-8315"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FOUR WINDS MANOR, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-17",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "RETRUM",
        "authorized_official_first_name": "JUANITA",
        "authorized_official_middle_name": "ROSE",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "608-845-6465",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "WI",
            "license": "1002",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "20154000",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Four Winds Manor and Lodge, Inc.",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Verona, WI

Sources for this page

Verify at the official NPI Registry.