Organization Active NPI

Augusta Area Home, Inc

  • Skilled Nursing Facility
  • Augusta, WI
National Provider Identifier
1093701088
Registry record updated Jan 13, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
2083 Issued in WI
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, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 13, 2025

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)CodeLicenseStatePrimary
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

IdentifierTypeStateIssuer
20010300MedicaidWI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
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
CorporationNon-profit
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 RehabilitationCCN 525535 · All quality measures
Overall star rating
2 of 5
Health inspections
3 of 5
Staffing
1 of 5
Quality measures
3 of 5
Type
Medicare and Medicaid
Ownership
For profit - Corporation
Certified
Jun 1, 1994
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
5036.3 residents per day on average

Processed by Care Compare on Aug 1, 2026.

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
52D0873182Augusta Area Home901 Bridge Creek Lane, Augusta, WI 54722Certificate of waiverJul 7, 2027

National Provider Directory

National Provider Directory

Ownership & 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.

NameRoleSinceShare
Victoria L Vande Zande Individual Operational/Managerial Control Jul 1, 2024
Adp of the SNF Apr 18, 2025
Kim a Krueger Individual Corporate Officer May 5, 2011
Adp of the SNF May 5, 2011
Individual Adp of the SNF Jul 30, 2021
Individual Adp of the SNF Jan 1, 2022
Organization, Eau Claire, WI Corporation, Medical provider/supplier, Consulting firm, For-profit Adp of the SNF Jan 13, 2025
Augusta Area Home, Inc Organization, Augusta, WI Created for acquisition, Corporation, Non-profit 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%
Individual Adp of the SNF Oct 24, 2016
Organization, Saint Charles, MO Corporation, Consulting firm, For-profit Adp of the SNF Jan 13, 2025
Organization, Milford, IA LLC, Medical staffing company, For-profit Adp of the SNF Apr 22, 2025
Individual Adp of the SNF Oct 23, 2014
Individual Adp of the SNF Mar 27, 2023
Jahn B Bradley Individual Corporate DirectorAdministrator 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.

Practitioners & affiliated clinicians

Affiliated clinicians 2

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

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

Verify at the official NPI Registry.