Active NPI
Augusta Area Home, Inc
- Skilled Nursing Facility
- Augusta, WI
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Skilled Nursing Facility
- License
- 2083
- Legal business name
- AUGUSTA AREA HOME, INC
- Practice address
- 901 Bridge Creek LN
Augusta, WI 54722-2603 - Phone
- (715) 286-2266
- Fax
- (715) 286-2653
- NPI assigned
- Sep 23, 2005
- Last updated
- Jan 13, 2025
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mr. Jahn B Bradley
- Title
- Administrator
- Phone
- (715) 286-2266
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Assisted Living Facility | 310400000X | NU | ||
| Skilled Nursing Facility | 314000000X | 2083 | WI | Primary |
Addresses
Primary practice location
901 Bridge Creek LN
Augusta, WI 54722-2603
Mailing address
901 Bridge Creek LN
Augusta, WI 54722-2603
Phone (715) 286-2266
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 20010300 | Medicaid | WI |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in WI
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20120813000748 | WI | Part A Provider - Skilled Nursing Facility | 4385890003 | Practice locations: Augusta, WI |
NPI to CCN mapping 1
The Medicare certification numbers (CCNs) connected to NPI 1093701088. Details of each certification follow.
Skilled nursing facility certification: CCN 525535
- Legal name
- AUGUSTA AREA HOME, INC
- Doing business as
- AUGUSTA HEALTH AND REHABILITATION
- Certification status
- Active
- Provider type (POS)
- Nursing home – SNF/NF dual certification
- Participating since
- Jun 1, 1994
- Last certification
- Feb 6, 2025
- Beds
- 50
- Ownership / control type
- Corporation
- Organization structure
- Corporation
- Incorporated
- Nov 1, 1966 in WI
- Enrollment address
- 901 Bridge Creek LN
Augusta, WI 54722-2603 - Nursing home name
- AUGUSTA HEALTH AND REHABILITATION
Care Compare: Nursing home
Medicare Care Compare- Listed as
- Augusta Health and Rehabilitation
- Overall star rating
- Health inspections
- Staffing
- Quality measures
- Type
- Medicare and Medicaid
- Ownership
- For profit - Corporation
- Certified
- Jun 1, 1994
- Medicare certification status
- Active
- Certified beds
- 50
Laboratory certificates & supplier records
Derived by NPIMapThese CMS records do not include an NPI. They are shown because their name and street address match this provider’s.
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 52D0873182 | Augusta Area Home | Certificate of waiver | Jul 7, 2027 |
National Provider Directory
National Provider DirectoryOwnership & related parties
All disclosed owners & managing parties 12
As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.
| Name | Role | Since | Share |
|---|---|---|---|
| Victoria L Vande Zande | Operational/Managerial Control | Jul 1, 2024 | |
| Adp of the SNF | Apr 18, 2025 | ||
| Kim a Krueger | Corporate Officer | May 5, 2011 | |
| Adp of the SNF | May 5, 2011 | ||
| Adp of the SNF | Jul 30, 2021 | ||
| Adp of the SNF | Jan 1, 2022 | ||
| Adp of the SNF | Jan 13, 2025 | ||
| Augusta Area Home, Inc | 5% Or Greater Direct Ownership Interest | Aug 1, 1968 | 100% |
| Operational/Managerial Control | Aug 1, 1968 | ||
| Adp of the SNF | Aug 1, 1968 | ||
| Direct Ownership Interest | Aug 1, 1968 | 100% | |
| Adp of the SNF | Oct 24, 2016 | ||
| Adp of the SNF | Jan 13, 2025 | ||
| Adp of the SNF | Apr 22, 2025 | ||
| Adp of the SNF | Oct 23, 2014 | ||
| Adp of the SNF | Mar 27, 2023 | ||
| Jahn B Bradley | Corporate Director | Apr 15, 2013 | 100% |
| Operational/Managerial Control | Apr 15, 2013 | ||
| Adp of the SNF | Apr 15, 2013 |
Owners & managing parties with NPI records 1
Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.
-
- Internal Medicine Physician
- Eau Claire, WI
- NPI 1083711279
Adp of the SNF, Operational/Managerial Control
Practitioners & affiliated clinicians
Affiliated clinicians 2
Clinicians who list this facility as an affiliation in Medicare Care Compare.
-
- Internal Medicine Physician
- Eau Claire, WI
- NPI 1083711279
Nursing home
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1127433600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1736726400000",
"number": "1093701088",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "901 BRIDGE CREEK LN",
"city": "AUGUSTA",
"state": "WI",
"postal_code": "547222603",
"telephone_number": "715-286-2266",
"fax_number": "715-286-2653"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "901 BRIDGE CREEK LN",
"city": "AUGUSTA",
"state": "WI",
"postal_code": "547222603",
"telephone_number": "715-286-2266",
"fax_number": "715-286-2653"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "AUGUSTA AREA HOME, INC",
"organizational_subpart": "NO",
"enumeration_date": "2005-09-23",
"last_updated": "2025-01-13",
"certification_date": "2025-01-13",
"status": "A",
"authorized_official_last_name": "BRADLEY",
"authorized_official_first_name": "JAHN",
"authorized_official_middle_name": "B",
"authorized_official_title_or_position": "ADMINISTRATOR",
"authorized_official_telephone_number": "715-286-2266",
"authorized_official_name_prefix": "Mr."
},
"taxonomies": [
{
"code": "310400000X",
"taxonomy_group": "",
"desc": "Assisted Living Facility",
"state": "NU",
"license": null,
"primary": false
},
{
"code": "314000000X",
"taxonomy_group": "",
"desc": "Skilled Nursing Facility",
"state": "WI",
"license": "2083",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "20010300",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Augusta, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 13, 2025; 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.