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SOUTHERN WISCONSIN CENTER
NPI 1043326747
Intermediate Care Facility, Intellectual Disabilities in Union Grove, WI

Active since August 22, 2006CLIA 52D0879904 · Waiver
21425 SPRING ST, UNION GROVE, WI 53182(262) 878-2411(262) 878-2922 Get Directions Write a Review

NPPES record last updated: February 14, 2008. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Southern Wisconsin Center NPPES

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

SOUTHERN WISCONSIN CENTER (NPI 1043326747) is a healthcare organization registered as an intermediate care facility, intellectual disabilities in Union Grove, Wisconsin and active in the NPI registry since August 2006. The organization holds a CLIA Waiver certificate valid through December 2, 2027 and lists James E Hutchison, Nursing Home Administrator, as its authorized official.

NPPES Registry Identity

NPI1043326747
Entity TypeOrganization
Primary Taxonomy315P00000X
Legal Business NameSTATE OF WISCONSIN
Location Address21425 SPRING STUnion Grove, WI 53182-9707
Mailing Address21425 Spring StUnion Grove, WI 53182-9707 · (262) 878-2411 · Fax (262) 878-2922
Phone(262) 878-2411
Fax(262) 878-2922
Organization SubpartNo
Authorized OfficialJames E HutchisonNursing Home Administrator · (262) 878-2411
Enumeration DateAugust 22, 2006
Last NPPES UpdateFebruary 14, 2008
✔ NPI 1043326747 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyIntermediate Care Facility, Intellectual DisabilitiesNursing & Custodial Care Facilities
Taxonomy Code315P00000X
License✔ Licensed in WI · 2763
Definition
An intermediate care facility providing services for individuals with intellectual disabilities.
21425 SPRING ST, Union Grove, WI 53182
Open in Google Maps ↗

Other Names 1

Doing Business AsSouthern Wisconsin Center

Other Identifiers 1

Medicaid21050000WI

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 52D0879904

Southern Wisconsin Center · Union Grove, WI
Active · expires Dec 2, 2027
CLIA Number52D0879904
Laboratory TypeIntermediate Care Facility For Mentally Retarded
Certificate Effective DateDecember 3, 2025
Certificate Expiration DateDecember 2, 2027
Laboratory DirectorKristina Kehrer
Laboratory Phone(262) 878-2411
Laboratory LocationSouthern Wisconsin Center21425 Spring St, Union Grove, WI 53182
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 18

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

KARRYLYN K KAIS
Speech-Language Pathologist
21425 SPRING ST
UNION GROVE, WI 53182
Racine County (262) 878-2411
DR. ANNE M SCHLIMGEN MD
Internal Medicine
21425 SPRING ST, UNION GROVE VA CLINIC
UNION GROVE, WI 53182
Racine County (414) 878-7001
JOSHUA D PHILLIPS M.D.
Psychiatry & Neurology (Psychiatry)
21425 SPRING ST
UNION GROVE, WI 53182
Racine County (262) 878-2411
SIMONIDA KOKANOVIC M.D.
Family Medicine
21425 SPRING ST
UNION GROVE, WI 53182
Racine County (262) 878-2411
IWONA M. PAKULA-HALLER M.D.
Psychiatry & Neurology (Psychiatry)
21425 SPRING ST, PRIMARY CARE UNION GROVE
UNION GROVE, WI 53182
Racine County (262) 878-7001
LORELEI L VOLSTAD NP
Nurse Practitioner
21425 SPRING ST
UNION GROVE, WI 53182
Racine County (262) 878-6746
LANA R. BUTTKE NP
Nurse Practitioner
21425 SPRING ST
UNION GROVE, WI 53182
Racine County (262) 878-7001
MILWAUKEE VAMC
Clinic/Center (VA)
21425 SPRING ST
UNION GROVE, WI 53182
Racine County (608) 821-7200

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 State Of Wisconsin's NPI number?

The NPI number for State Of Wisconsin is 1043326747. It was assigned to this organization in the NPPES registry on August 22, 2006. The provider is doing business as Southern Wisconsin Center.

Where is State Of Wisconsin located?

State Of Wisconsin is located at 21425 Spring St, Union Grove, WI 53182. The listed phone number is (262) 878-2411.

What is State Of Wisconsin's specialty?

The primary specialty registered for this NPI is Intermediate Care Facility, Intellectual Disabilities with taxonomy code 315P00000X.

Does State Of Wisconsin hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 52D0879904) is associated with this NPI, valid through December 2, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for State Of Wisconsin was last updated on February 14, 2008. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 18 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.