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EDGEWATER HAVEN NURSING HOME
NPI 1013915339
Skilled Nursing Facility in Port Edwards, WI

Active since July 11, 2005CLIA 52D0693021 · Waiver
5/5
Overall Rating
1351 WISCONSIN RIVER DR, PORT EDWARDS, WI 54469(715) 885-8300(715) 885-8351 Get Directions Write a Review

NPPES record last updated: September 9, 2022. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Edgewater Haven Nursing Home NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

EDGEWATER HAVEN NURSING HOME (NPI 1013915339) is a healthcare organization registered as a skilled nursing facility in Port Edwards, Wisconsin and active in the NPI registry since July 2005. The organization holds a CLIA Waiver certificate valid through August 31, 2026 and lists Kyle Theiler, Administrator, as its authorized official.

NPPES Registry Identity

NPI1013915339
Entity TypeOrganization
Primary Taxonomy314000000X
Legal Business NameCOUNTY OF WOOD
Location Address1351 WISCONSIN RIVER DRPort Edwards, WI 54469-1041
Mailing Address1351 Wisconsin River DrPort Edwards, WI 54469-1099 · (715) 885-8300 · Fax (715) 885-8351
Phone(715) 885-8300
Fax(715) 885-8351
Organization SubpartNo
Authorized OfficialKyle TheilerAdministrator · (715) 885-8324
Enumeration DateJuly 11, 2005
Last NPPES UpdateSeptember 9, 2022
NPPES CertifiedSeptember 9, 2022
✔ NPI 1013915339 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtySkilled Nursing FacilityNursing & Custodial Care Facilities
Taxonomy Code314000000X
License✔ Licensed in WI · 2369
Definition
(1) A skilled nursing facility is a facility or distinct part of an institution whose primary function is to provide medical, continuous nursing, and other health and social services to patients who are not in an acute phase of illness requiring services in a hospital, but who require primary restorative or skilled nursing services on an inpatient basis above the level of intermediate or custodial care in order to reach a degree of body functioning to permit self care in essential daily living. It meets any licensing or certification standards et forth by the jurisdiction where it is located. A skilled nursing facility may be a freestanding facility or part of a hospital that has been certified by Medicare to admit patients requiring subacute care and rehabilitation; (2) Provides non-acute medical and skilled nursing care services, therapy and social services under the supervision of a licensed registered nurse on a 24-hour basis.
1351 WISCONSIN RIVER DR, Port Edwards, WI 54469
Open in Google Maps ↗

Other Names 1

Doing Business AsEdgewater Haven Nursing Home

Other Identifiers 1

Medicaid20131100WI

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Anthem Blue Cross and Blue Shield, HealthPartners, Security Health Plan.Insurance ›

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 52D0693021

Edgewater Haven Nursing Home · Port Edwards, WI
Active · expires Aug 31, 2026
CLIA Number52D0693021
Laboratory TypeSkilled Nursing Facility/Nursing Facility
Certificate Effective DateSeptember 1, 2024
Certificate Expiration DateAugust 31, 2026
Laboratory DirectorMs. Joanne Rodriguez
Laboratory Phone(715) 885-8300
Laboratory LocationEdgewater Haven Nursing Home1351 Wisconsin River Dr, Port Edwards, WI 54469
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Nursing Home Quality Ratings CMS Care Compare

Quality ratings, staffing and inspection history for Edgewater Haven Nursing Home (CMS certification number 525088), from CMS Care Compare.

Edgewater Haven Nursing Home

Nursing home · Port Edwards, WI
5/5 CMS Overall Rating
OwnershipGovernment - County
CMS Certification Number525088
Certified Beds79 beds47 residents per day on average
Medicare & Medicaid Participant SinceJanuary 1, 1967
Resident & Family CouncilResident council
Automatic sprinkler system

CMS Star Ratings

Quality Measures
Based on a select set of clinical quality measures.
5/5
Long-Stay Quality
Quality of care delivered to long-term residents.
5/5
Short-Stay Quality
Quality of care delivered to short-term and rehabilitation residents.
5/5
Staffing
Based on nursing staff hours relative to resident needs.
5/5
Weighted Health Inspection Score
Lower scores are better; the score summarizes deficiencies found on recent inspections.
27.33
Ratings are assigned by CMS on a one-to-five star scale; five is the highest. Categories without a current CMS rating are not shown.

Staffing & Turnover

Total Nurse Staffing
nurse aide 2.84 · LPN 0.71 · RN 1.47
5.02 hrs per resident per day
Weekend Nurse Staffing
4.3 hrs per resident per day
Physical Therapist Staffing
0.02 hrs per resident per day
Nursing Staff Turnover
Share of nursing staff who left the facility within the past year.
18.9%
Registered Nurse Turnover
25%
Administrators Who Have Left
In the past year.
2
Higher staffing hours generally allow more direct care time per resident.

Inspections & Enforcement

Facility-Reported Incidents
0
Substantiated Complaints
0
Fines
0
Medicare Payment Denials
0
Total Penalties
0
Counts come from CMS inspections and complaint investigations over approximately the past three years. CMS Care Compare data as of October 1, 2024.

Other Providers at the Same Location NPPES 7

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

CHARLENE M MARSHALL
Physical Therapy Assistant
1351 WISCONSIN RIVER DR
PORT EDWARDS, WI 54469
Wood County (715) 885-8305
SIDRAH AMHED KHAN
Speech-Language Pathologist
1351 WISCONSIN RIVER DR
PORT EDWARDS, WI 54469
Wood County (715) 885-8333
MRS. DIANNA WITT COTA
Occupational Therapy Assistant
1351 WISCONSIN RIVER DR
PORT EDWARDS, WI 54469
Wood County (715) 885-8300
MRS. LISA LYNN O'SHASKY COTA
Occupational Therapy Assistant
1351 WISCONSIN RIVER DR
PORT EDWARDS, WI 54469
Wood County (715) 885-8300
MRS. SHARON K. HOLY P.T.
Physical Therapist (Geriatrics)
1351 WISCONSIN RIVER DR
PORT EDWARDS, WI 54469
Wood County (715) 885-8300
MICHAEL LYNN BERNARDE PTA
Physical Therapy Assistant
1351 WISCONSIN RIVER DR
PORT EDWARDS, WI 54469
Wood County (715) 885-8300
MS. AMANDA SUE VERIHA LPTA
Physical Therapy Assistant
1351 WISCONSIN RIVER DR
PORT EDWARDS, WI 54469
Wood County (715) 885-8300

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is County Of Wood's NPI number?

The NPI number for County Of Wood is 1013915339. It was assigned to this organization in the NPPES registry on July 11, 2005. The provider is doing business as Edgewater Haven Nursing Home.

Where is County Of Wood located?

County Of Wood is located at 1351 Wisconsin River Dr, Port Edwards, WI 54469. The listed phone number is (715) 885-8300.

What is County Of Wood's specialty?

The primary specialty registered for this NPI is Skilled Nursing Facility with taxonomy code 314000000X.

Does County Of Wood hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 52D0693021) is associated with this NPI, valid through August 31, 2026. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

Is County Of Wood a Medicare-certified nursing home?

Yes. Edgewater Haven Nursing Home is a Medicare-certified nursing home with 79 certified beds.

What quality rating does County Of Wood have?

CMS rates Edgewater Haven Nursing Home 5 out of 5 stars overall on Care Compare. The full measure detail is in the Nursing Home Quality Ratings section above.

What insurance does County Of Wood accept?

Health plans from Anthem Blue Cross and Blue Shield, HealthPartners and Security Health Plan list County Of Wood as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for County Of Wood was last updated on September 9, 2022. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.