Polk County-Dept of Administration
Organization Active NPI Nursing Facility/Intermediate Care Facility · Amery, WI
NPI 1215981998 · NPPES record last updated Dec 9, 2024
Key facts
- NPI
- 1215981998
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Nursing Facility/Intermediate Care Facility 313M00000X
- License
- 2376 (WI)
- Legal business name
- POLK COUNTY-DEPT OF ADMINISTRATION
- Practice address
- 220 Scholl CT
Amery, WI 54001-1440 - Phone
- (715) 268-7107
- Fax
- (715) 268-6167
- NPI assigned
- May 19, 2006
- Organization subpart
- Yes
- Parent organization (as reported)
- POLK COUNTY-DEPT OF ADMINISTRATION
Authorized official
- Name
- Dana Reese, LNHA
- Title
- Nursing Home Administrator
- Phone
- (715) 268-7107
Owners & managing parties with NPI records 2
Other NPIs with the same Medicare PAC ID 2
Corporate family (same tax ID) 6
Practitioners 2
-
Kevin J Montague, MS, LPC, LSAC, LSW
Affiliated clinicians 1
Medicare Care Compare: Nursing home
- Listed as
- Golden Age Manor
- Overall star rating
- ★★☆☆☆ 2 of 5
- Health inspections
- ★★☆☆☆ 2 of 5
- Staffing
- ★★★★☆ 4 of 5
- Quality measures
- ★★★☆☆ 3 of 5
- Type
- Medicare and Medicaid
- Ownership
- Government - County
- Certified
- May 1, 1993
- Medicare certification status
- Active
- Certified beds
- 85 · 58.7 residents per day on average
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WI
Skilled nursing facility certification: CCN 525507
- Legal name
- POLK COUNTY-DEPT OF ADMINISTRATION
- Certification status
- Active
- Provider type (POS)
- Nursing home – SNF/NF dual certification
- Participating since
- May 1, 1993
- Last certification
- Apr 10, 2025
- Beds
- 85
- Ownership / control type
- County
- Organization structure
- Other · Non-profit
- Enrollment address
- 220 Scholl CT
Amery, WI 54001-1298 - Nursing home name
- GOLDEN AGE MANOR
All disclosed owners & managing parties 3
| Name | Role | Since | Share |
|---|---|---|---|
| Dana Reese |
Operational/Managerial Control | Nov 23, 2011 | |
| Adp of the SNF | Jan 28, 2025 | ||
| Polk County-Dept of Administration |
5% Or Greater Direct Ownership Interest | Jan 1, 1966 | 100% |
| Operational/Managerial Control | Jan 1, 1966 | 100% | |
| |
Adp of the SNF | Jan 1, 2025 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20110815000930 | WI | Part a Provider - Skilled Nursing Facility | 4587560586 | Practice locations: Amery, WI |
National Provider Directory
- Tax ID family
- Polk County Public HLTH
- Part of
- Polk County Public HLTH
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nursing Facility/Intermediate Care Facility | 313M00000X | 2376 | WI | Yes |
Addresses
Primary practice location
220 Scholl CT
Amery, WI 54001-1440
Mailing address
220 Scholl CT
Amery, WI 54001-1440
Phone (715) 268-7107
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 20133000 | Medicaid | WI |
Other providers in Amery, WI
- Jacqueline Peterson
- Margie H Peterson
- Jonathan David Platson
- William Gregory Platz
- Douglas D Podoll
- Kenzie Prater
- Joseph Janka Putz
- James P Quenan
- Nancy A Reinhardt
- Deborah Rickard
All providers in Amery, WI · Nursing Facility/Intermediate Care Facility in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 9, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.