St Joseph Residence Inc

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

2040 Issued in WI

Legal business name

ST JOSEPH RESIDENCE INC

Practice address

107 E Beckert Road
New London, WI 54961-2598

Phone

(920) 982-5354

Fax

(920) 982-5420

NPI assigned

Jun 28, 2005

Organization subpart

No

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

Authorized official

Name

Mr. Daniel W Orr

Title

Administrator

Phone

(920) 982-5354

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in WI

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1073510632. Details of each certification follow.

• CCN 525599 Skilled nursing facility · Active · Details

Skilled nursing facility certification: CCN 525599

Legal name

ST JOSEPH RESIDENCE INC

Certification status

Active

Provider type (POS)

Nursing home – SNF/NF dual certification

Participating since

Sep 1, 1996

Last certification

Aug 7, 2024

Beds

50

Ownership / control type

Church Related

Organization structure

CorporationNon-profit

Incorporated

Jan 1, 1965 in WI

Enrollment address

107 E Beckert Rd
New London, WI 54961-2509

Nursing home name

ST JOSEPH RESIDENCE

Listed as

St Joseph ResidenceCCN 525599 · All quality measures

Overall star rating

5 of 5

Health inspections

4 of 5

Staffing

5 of 5

Quality measures

5 of 5

Type

Medicare and Medicaid

Ownership

Non profit - Church related

Certified

Sep 1, 1996

Medicare certification status

ActiveFrom the Provider of Services file

Certified beds

5042.3 residents per day on average

Processed by Care Compare on Aug 1, 2026.

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

All disclosed owners & managing parties 11

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

Affiliated clinicians 2

Clinicians who list this facility as an affiliation in Medicare Care Compare.

• Shayna Kamin, DO

  • Geriatric Medicine (Family Medicine) Physician
  • Appleton, WI
  • NPI 1609281567

  Nursing home

  Care Compare affiliation
• Carol A Veltus, DNP, APNP, FNP-BC

  • Family Nurse Practitioner
  • Menasha, WI
  • NPI 1487080446

  Nursing home

  Care Compare affiliation

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1119916800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1073510632",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "107 E BECKERT ROAD",
            "city": "NEW LONDON",
            "state": "WI",
            "postal_code": "549612598",
            "telephone_number": "920-982-5354",
            "fax_number": "920-982-5420"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "107 E BECKERT ROAD",
            "city": "NEW LONDON",
            "state": "WI",
            "postal_code": "549612598",
            "telephone_number": "920-982-5354",
            "fax_number": "920-982-5420"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST JOSEPH RESIDENCE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-06-28",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "ORR",
        "authorized_official_first_name": "DANIEL",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "920-982-5354",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "WI",
            "license": "2040",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "20132400",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Alexander L Sommers, MD
• Amy J Sordahl, MSPT
• Lindsey Spiegelberg
• Mary Joann Spiller, NP
• Nicholas John Sprangers, PHARMD
• Pamela J. St. Clair, P.T.
• St. Joseph Residence, Inc. - the Washington Center
• Sundance Services Corp (Genesis Rehab Services)
• Craig E Sylte, O.D.
• Mark Alan Tegtmeier, MA, LCSW, LPC, LMFT

• Skilled Nursing Facility in New London, WI
• Providers in New London, WI by specialty
• Skilled Nursing Facility in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.