NPIMap

Organization Active NPI

Great Lakes Healthcare, Inc.

  • Community Based Hospice Care Agency
  • Mount Pleasant, WI
National Provider Identifier
1922898360
Registry record updated Mar 23, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Based Hospice Care AgencyTaxonomy code 251G00000X
Legal business name
GREAT LAKES HEALTHCARE, INC.
Practice address
6211 Durand Ave Ste 102
Mount Pleasant, WI 53406-4956
Phone
(262) 381-3931
NPI assigned
May 8, 2025
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 23, 2026

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

Authorized official

Name
Amber L Tueller
Title
Secretary
Phone
(208) 207-2726

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community Based Hospice Care Agency 251G00000X Primary

Addresses

Primary practice location

6211 Durand Ave Ste 102
Mount Pleasant, WI 53406-4956

Mailing address

6211 Durand Ave Ste 102
Mount Pleasant, WI 53406-4956
Phone (262) 381-3931

Other names 1

  • Preceptor Hospice South Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20250731001715 WI Part A Provider - Hospice 5395079719 Practice locations: Mount Pleasant, WI

Hospice certification: CCN 521627

Legal name
GREAT LAKES HEALTHCARE INC
Doing business as
PRECEPTOR HOSPICE SOUTH
Certification status
Active
Provider type (POS)
Hospice
Participating since
Sep 11, 2025
Last certification
Sep 11, 2025
Ownership / control type
Proprietary - Corporation
Organization structure
CorporationProprietary
Enrollment address
6211 Durand Ave
Ste 102
Mount Pleasant, WI 53406-4956

Other NPIs with the same Medicare PAC ID 2

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

Care Compare: Hospice

Medicare Care Compare
Listed as
Preceptor Hospice SouthCCN 521627
Certified
Sep 11, 2025
Medicare certification status
ActiveFrom the Provider of Services file

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
52D2330433Great Lakes Healthcare, Inc6211 Durand Ave, Ste 102, Mount Pleasant, WI 53406Certificate of waiverSep 15, 2027

National Provider Directory

National Provider Directory
Tax ID family
Great Lakes Healthcare Inc3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

Locations

1211 Rickmeyer Dr
Ste A
Fond du Lac, WI 54937
Phone (920) 827-4555

6211 Durand Ave
Ste 102
Mount Pleasant, WI 53406
Phone (262) 381-3931

6211 Durand Ave
Ste 103
Mount Pleasant, WI 53406

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.

NameRoleSinceShare
Cornerstone Healthcare Inc Organization, Eagle, ID Corporation, For-profit, Owned by another organization or individual 5% Or Greater Direct Ownership Interest Jun 1, 2025 100%
Brent Mills Individual Corporate OfficerTreasurer Mar 26, 2026
Brent Guerisoli Individual Corporate DirectorDirector & Sole Board Member Jun 1, 2025
Kamryn Hallman Individual W-2 Managing EmployeeAd; May 19, 2026
The Pennant Group Inc Organization, Eagle, ID Corporation, For-profit 5% Or Greater Indirect Ownership Interest Jun 1, 2025 100%
John J Gochnour Individual Corporate OfficerPresident Jun 1, 2025
Brian Wolter Individual W-2 Managing EmployeeMD; Jun 1, 2025
Amber Tueller Individual Corporate OfficerSecretary Jun 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.

Facilities with the same owner 141

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

View all 141

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": "1746662400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1774224000000",
    "number": "1922898360",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6211 DURAND AVE STE 102",
            "city": "MOUNT PLEASANT",
            "state": "WI",
            "postal_code": "534064956",
            "telephone_number": "262-381-3931"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6211 DURAND AVE STE 102",
            "city": "MOUNT PLEASANT",
            "state": "WI",
            "postal_code": "534064956",
            "telephone_number": "262-381-3931"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREAT LAKES HEALTHCARE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-05-08",
        "last_updated": "2026-03-23",
        "certification_date": "2026-03-23",
        "status": "A",
        "authorized_official_last_name": "TUELLER",
        "authorized_official_first_name": "AMBER",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "SECRETARY",
        "authorized_official_telephone_number": "208-207-2726"
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Preceptor Hospice South",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Mount Pleasant, WI

Sources for this page

Verify at the official NPI Registry.