SHADY LANE HOME, INC.
NPI 1518926211
Skilled Nursing Facility in Manitowoc, WI

Active since March 21, 2006CLIA 52D0662593 · Waiver
1235 S 24TH ST, MANITOWOC, WI 54220(920) 682-8254(920) 682-8315 Get Directions Write a Review

NPPES record last updated: December 31, 2020. Verified against the NPPES registry weekly; last sync: October 04, 2026.

Record update history: Dec 31, 2020, Dec 30, 2016 (2 updates tracked since 2016).

About Shady Lane Home, Inc. NPPES

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

SHADY LANE HOME, INC. (NPI 1518926211) is a healthcare organization registered as a skilled nursing facility in Manitowoc, Wisconsin and active in the NPI registry since March 2006. The organization holds a CLIA Waiver certificate valid through August 31, 2028 and lists Lisa M Wetenkamp, Accounts Receivable, as its authorized official.

NPPES Registry Identity

NPI1518926211
Entity TypeOrganization
Primary Taxonomy314000000X
Legal Business NameSHADY LANE HOME, INC.
Location Address1235 S 24TH STManitowoc, WI 54220-5516
Mailing Address1235 S 24th StManitowoc, WI 54220-5516 · (920) 682-8254 · Fax (920) 682-8315
Fax(920) 682-8315
Organization SubpartNo
Authorized OfficialLisa M WetenkampAccounts Receivable · (920) 682-8254
Enumeration DateMarch 21, 2006
Last NPPES UpdateDecember 31, 20202 updates tracked since enumeration
NPPES CertifiedDecember 31, 2020
✔ NPI 1518926211 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 · 2250
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.
1235 S 24TH ST, Manitowoc, WI 54220

Other Identifiers 1

Medicaid20158400WI

Accepted 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 52D0662593

Shady Lane Inc · Manitowoc, WI
Active · expires Aug 31, 2028
CLIA Number52D0662593
Laboratory TypeSkilled Nursing Facility/Nursing Facility
Certificate Effective DateSeptember 1, 2026
Certificate Expiration DateAugust 31, 2028
Laboratory DirectorDeanne Weier
Laboratory Phone(920) 682-8254
Laboratory LocationShady Lane Inc1235 S 24th St, Manitowoc, WI 54220
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 7

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

Occupational Therapist
1235 S 24TH ST
MANITOWOC, WI 54220
Occupational Therapist
1235 S 24TH ST, ATTN REHABCARE
MANITOWOC, WI 54220
Physical Therapist
1235 S 24TH ST
MANITOWOC, WI 54220
Nurse Practitioner
1235 S 24TH ST
MANITOWOC, WI 54220
Physical Therapist
1235 S 24TH ST
MANITOWOC, WI 54220
Speech-Language Pathologist
1235 S 24TH ST
MANITOWOC, WI 54220
Occupational Therapy Assistant
1235 S 24TH ST
MANITOWOC, WI 54220

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 Shady Lane Home, Inc.'s NPI number?

The NPI number for Shady Lane Home, Inc. is 1518926211. It was assigned to this organization in the NPPES registry on March 21, 2006.

Where is Shady Lane Home, Inc. located?

Shady Lane Home, Inc. is located at 1235 S 24th St, Manitowoc, WI 54220. The listed phone number is (920) 682-8254.

What is Shady Lane Home, Inc.'s specialty?

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

Does Shady Lane Home, Inc. hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 52D0662593) is associated with this NPI, valid through August 31, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

What insurance does Shady Lane Home, Inc. accept?

Health plans from Anthem Blue Cross and Blue Shield, CareSource (Common Ground Healthcare), HealthPartners, Quartz and UnitedHealthcare list Shady Lane Home, Inc. 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 Shady Lane Home, Inc. was last updated on December 31, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 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.