STATE OF WISCONSIN (NPI# 1366439986) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1366439986 |
| Entity Type | Organization |
| Organization Name | STATE OF WISCONSIN |
| Other Organization Name | THE WISCONSIN VETERANS HOME AT KING |
| Practice Address |
N2665 County Road Qq King WI 54946 |
| Mailing Address |
N2665 County Road Qq King WI 54946-0600 |
| Practice Telephone | 7152585586 |
| Practice Fax Number | 7152581677 |
| Mailing Telephone | 7152585586 |
| Mailing Fax Number | 7152581677 |
| Enumeration Date | 2005-09-29 |
| Last Update Date | 2019-08-27 |
| Authorized Official Name | TAMMY SERVATIUS (INTERIM COMMANDANT) |
| Authorized Official Telephone | 7152585586 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 314000000X | Skilled Nursing Facility | 2485 | WI | Nursing & Custodial Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| WI | 20135000 | 05 |
| Other Name | Type Code |
|---|---|
| The Wisconsin Veterans Home At King | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1558615815 | State of Wisconsin | Skilled Nursing Facility | 2175 E Park Ave, Chippewa Falls, WI 54729-3511 | 2012-11-07 |
| 1225152861 | State of Wisconsin | Skilled Nursing Facility | 21425g Spring St, Union Grove, WI 53182-9707 | 2007-03-19 |
| 1235225616 | State of Wisconsin | Intermediate Care Facility, Mentally Retarded | 2820 East Park Avenue, Chippewa Falls, WI 54729-0340 | 2006-10-05 |
| 1225362403 | State of Wisconsin | Durable Medical Equipment & Medical Supplies | 317 Knutson Dr, Madison, WI 53704-1133 | 2009-09-22 |
| 1336324946 | State of Wisconsin | Intermediate Care Facility, Mentally Retarded | 317 Knutson Dr, Madison, WI 53704-1133 | 2008-01-02 |
| 1588703078 | State of Wisconsin | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 317 Knutson Dr, Madison, WI 53704-1133 | 2007-02-05 |
| 1386705655 | State of Wisconsin | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 317 Knutson Dr, Madison, WI 53704-1133 | 2006-12-12 |
| 1164516506 | State of Wisconsin | Psychiatric Hospital | 1300 South Drive, Winnebago, WI 54985-0009 | 2006-10-02 |
| 1437253648 | State of Wisconsin | General Acute Care Hospital | 301 Troy Dr, Madison, WI 53704-1521 | 2006-09-08 |
| 1043326747 | State of Wisconsin | Intermediate Care Facility, Mentally Retarded | 21425 Spring St, Union Grove, WI 53182-9707 | 2006-08-22 |
| Street Address |
N2665 COUNTY ROAD QQ |
| City | KING |
| State | WI |
| Zip Code | 54946 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1841851268 | Danielle Kaufert | Physical Therapy Assistant | N2665 County Road Qq, King, WI 54946-0600 | 2019-06-26 |
| 1992201578 | Melissa R Duberstein | Occupational Therapy Assistant | N2665 County Road Qq, King, WI 54946-0600 | 2018-04-03 |
| 1073029286 | Ashley Caves | Speech-Language Pathologist | N2665 County Road Qq, King, WI 54946-0600 | 2017-12-26 |
| 1558803007 | Cynthia Ann Rendall | Nurse Practitioner | N2665 County Road Qq, King, WI 54946-0600 | 2016-11-15 |
| 1568738029 | Lisa Lebouef | Speech-Language Pathologist | N2665 County Road Qq, Speech Therapy Department, King, WI 54946-0600 | 2012-03-29 |
| 1134400401 | Amie Anna Lee Greely | Physical Therapy Assistant | N2665 County Road Qq, King, WI 54946-0600 | 2011-08-31 |
| 1346538352 | Robin Lynn Delgado | Speech-Language Pathologist | N2665 County Road Qq, King, WI 54946-0600 | 2011-07-12 |
| 1205143542 | Jodi Ann Dailey | Nurse Practitioner | N2665 County Road Qq, King, WI 54946-0600 | 2010-09-08 |
| 1982846283 | James Alan Lebouef | Dentist | N2665 County Road Qq, Wisconsin Veterans Home/ Dental Clinic, King, WI 54946-0600 | 2009-04-01 |
| 1528248911 | Shiela Jean Schultz | Nurse Practitioner | N2665 County Road Qq, King, WI 54946-0600 | 2007-11-14 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1376653261 | Paul Joseph Drinkt | Internal Medicine | N2665 County Rd Qq, Wisconsin Veterans Home, King, WI 54946 | 2006-08-30 |
| 1306861836 | Barbara A Bergman | Licensed Practical Nurse | N2665 Highway Qq, Wisconsin Veterans Home Pharmacy, King, WI 54946 | 2006-07-13 |
| 1093891046 | Dean M Christensen | Pharmacist | N2665 County Rd Qq, King, WI 54946-0600 | 2006-10-31 |
| Taxonomy Code | 314000000X |
| Grouping | Nursing & Custodial Care Facilities |
| Classification | Skilled Nursing Facility |
| (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. |
| Notes: Source: (1) "Glossary of terms used in managed care" Developed by the Managed Care Assembly (MCA) of Medical Group Management Association (MGMA), MGM Journal, September/October 1995, p. 64; (2) AHA Guide, 1996 Annual Survey. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1629047279 | Universal Health Care / King, Inc | Skilled Nursing Facility | 115 White Rd, King, NC 27021-9526 | 2006-03-16 |
| 1417933615 | Autumn Corporation | Skilled Nursing Facility | 440 Ingram Road Ext., King, NC 27021 | 2005-12-20 |
| 1629515499 | Village Care of King, LLC | Skilled Nursing Facility | 440 Ingram Dr, King, NC 27021-8208 | 2017-01-31 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356962369 | Heritage Assisted Living, LLC | Skilled Nursing Facility | 5020 S 107th St, Greenfield, WI 53228-3267 | 2020-04-30 |
| 1235762881 | Imr Oak Creek Opco, LLC | Skilled Nursing Facility | 2700 West Honadel Boulevard, Oak Creek, WI 53154 | 2020-02-21 |
| 1831693936 | Golden Years Nursing Home, Inc. | Skilled Nursing Facility | 611 Harmony Dr, Lake Geneva, WI 53147-8800 | 2018-03-22 |
| 1801302732 | Oak Park Place of Janesville, LLC | Skilled Nursing Facility | 700 Myrtle Way, Janesville, WI 53545-9101 | 2017-12-14 |
| 1235674839 | Zachary Rader | Skilled Nursing Facility | 645 N Church St, Elkhorn, WI 53121-2204 | 2017-01-05 |
| 1982155248 | The Bethany-st. Joseph Corporation D/b/a Prairie Pointe Rehab Suites | Skilled Nursing Facility | 286 N. Willson Dr, Altoona, WI 54720 | 2016-10-20 |
| 1316492317 | Darcy Christiansen | Skilled Nursing Facility | 4427 E Pic A Dilly Dr, Janesville, WI 53546-9606 | 2016-08-19 |
| 1366895583 | Jeffrey Alan Weinshrott | Skilled Nursing Facility | 336 Wisconsin Ave, Sheboygan, WI 53081-4183 | 2016-07-22 |
| 1720433378 | Kendra Meyers | Skilled Nursing Facility | 1806 N Hume Ave Apt 4, Marshfield, WI 54449-1677 | 2016-05-02 |
| 1952756991 | Grace Lutheran Foundation Inc | Skilled Nursing Facility | 206 North Willson Drive, Altoona, WI 54720 | 2016-04-27 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.