State of Wisconsin
Organization Active NPI Skilled Nursing Facility · King, WI
NPI 1366439986 · NPPES record last updated Jan 6, 2026
Key facts
- NPI
- 1366439986
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Skilled Nursing Facility 314000000X
- License
- 2485 (WI)
- Legal business name
- STATE OF WISCONSIN
- Practice address
- N2665 County Road QQ
King, WI 54946 - Phone
- (715) 258-5586
- Fax
- (715) 258-1677
- NPI assigned
- Sep 29, 2005
- Organization subpart
- No
Authorized official
- Name
- Tammy Servatius
- Title
- Division of Homes Administrator
- Phone
- (715) 258-4251
Owners & managing parties with NPI records 3
-
Thanmayi Kaza, MD
Owned or controlled facilities with NPI records 2
Other NPIs with the same Medicare PAC ID 2
Member of 1
Facilities with the same owner 2
Affiliated clinicians 6
-
Angela Kaye Amos, MD
-
Trevor D Argall, MD, MS
-
Kelly Pucillo, MD
-
Robert William Sedlacek, M.D.
-
James P Spencer, MD
Medicare Care Compare: Nursing home
- Listed as
- WI Veterans Hm Ainsworth Hall
- Overall star rating
- ★★★★★ 5 of 5
- Health inspections
- ★★★☆☆ 3 of 5
- Staffing
- ★★★★★ 5 of 5
- Quality measures
- ★★★★★ 5 of 5
- Type
- Medicare and Medicaid
- Ownership
- Government - State
- Certified
- Mar 1, 2015
- Medicare certification status
- Active
- Certified beds
- 198 · 98.6 residents per day on average
Medicare Care Compare: Nursing home
- Listed as
- WI Veterans Home Moses Hall
- Overall star rating
- ★★★★★ 5 of 5
- Health inspections
- ★★★☆☆ 3 of 5
- Staffing
- ★★★★★ 5 of 5
- Quality measures
- ★★★★★ 5 of 5
- Type
- Medicare and Medicaid
- Ownership
- Government - State
- Certified
- Mar 1, 2015
- Medicare certification status
- Active
- Certified beds
- 192 · 184.1 residents per day on average
- Penalties (3 years)
- 1 · fines totaling $23,520
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in WI
Skilled nursing facility certification: CCN 525718
- Legal name
- STATE OF WISCONSIN
- Doing business as
- WISCONSIN VETERANS HOME AT KING - MOSES HALL
- Certification status
- Active
- Provider type (POS)
- Nursing home – SNF/NF dual certification
- Participating since
- Mar 1, 2015
- Last certification
- Mar 19, 2025
- Beds
- 192
- Ownership / control type
- State
- Multi-facility organization
- Wisconsin Department of Veterans Affairs
- Organization structure
- Government · Non-profit
- Enrollment address
- N2665 County Road QQ
King, WI 54946-0600 - Nursing home name
- WI VETERANS HOME MOSES HALL
Skilled nursing facility certification: CCN 525719
- Legal name
- STATE OF WISCONSIN
- Doing business as
- WISCONSIN VETERANS HOME AT KING - AINSWORTH HALL
- Certification status
- Active
- Provider type (POS)
- Nursing home – SNF/NF dual certification
- Participating since
- Mar 1, 2015
- Last certification
- Mar 19, 2025
- Beds
- 198
- Ownership / control type
- State
- Multi-facility organization
- Wisconsin Veterans Home
- Organization structure
- Government · Non-profit
- Enrollment address
- N2665 County Road QQ
King, WI 54946-0601 - Nursing home name
- WI VETERANS HM AINSWORTH HALL
All disclosed owners & managing parties 30
| Name | Role | Since | Share |
|---|---|---|---|
| Nicole Flack |
Operational/Managerial Control | Mar 15, 2020 | |
| Adp of the SNF | Mar 15, 2020 | ||
| James Bond |
Operational/Managerial Control | Jan 9, 2023 | |
| Managing Control - Governing Body |
Jan 9, 2023 | ||
| Adp of the SNF | Jan 9, 2023 | ||
| Thanmayi Kaza |
Operational/Managerial Control | Jul 31, 2023 | |
| Adp of the SNF | Jul 31, 2023 | ||
| Joni Steingraber |
Operational/Managerial Control | Jun 30, 2025 | |
| Adp of the SNF | Jun 30, 2025 | ||
| |
Adp of the SNF | May 29, 2025 | |
| State of Wisconsin |
5% Or Greater Direct Ownership Interest | Jul 1, 2014 | 100% |
| Operational/Managerial Control | Jul 1, 2014 | ||
| Adp of the SNF | Jul 1, 2014 | ||
| Polly Kimball |
Operational/Managerial Control | Mar 11, 2012 | |
| Adp of the SNF | Mar 11, 2012 | ||
| Bette Britz |
Operational/Managerial Control | May 4, 2015 | |
| Adp of the SNF | May 4, 2015 | ||
| Brad Butterfield |
Operational/Managerial Control | Nov 4, 2024 | |
| Adp of the SNF | Nov 4, 2024 | ||
| James Parker |
Operational/Managerial Control | Apr 22, 2012 | |
| Managing Control - Governing Body |
Apr 22, 2012 | ||
| Adp of the SNF | Apr 22, 2012 | ||
| Caitlin Mork |
Operational/Managerial Control | Jul 4, 2021 | |
| Adp of the SNF | Jul 4, 2021 | ||
| Jodie Schulz |
Operational/Managerial Control | Apr 23, 2023 | |
| Adp of the SNF | Apr 23, 2023 | ||
| Susan Fay |
Operational/Managerial Control | Jul 28, 2024 | |
| Adp of the SNF | Jul 28, 2024 | ||
| Brian Thibodeau |
Operational/Managerial Control | Oct 23, 2011 | |
| Adp of the SNF | Oct 23, 2011 | ||
| Gina Fernandez |
Operational/Managerial Control | Jan 14, 2024 | |
| Adp of the SNF | Jan 14, 2024 | ||
| Tammy L Servatius |
Operational/Managerial Control | Oct 14, 2025 | |
| Managing Control - Governing Body |
Oct 14, 2025 | ||
| Adp of the SNF | Oct 14, 2025 | ||
| Managing Control - Governing Body |
Oct 14, 2025 | ||
| Colt Cooney |
Operational/Managerial Control | Dec 2, 2024 | |
| Adp of the SNF | Dec 2, 2024 | ||
| |
Adp of the SNF | Apr 1, 2018 | |
| |
Adp of the SNF | Mar 15, 2020 | |
| |
Adp of the SNF | Jan 14, 2024 | |
| |
Adp of the SNF | Jul 4, 2021 | |
| |
Adp of the SNF | Apr 23, 2023 | |
| |
Adp of the SNF | Oct 23, 2011 | |
| |
Adp of the SNF | Nov 4, 2024 | |
| |
Adp of the SNF | Jul 28, 2024 | |
| |
Adp of the SNF | May 29, 2025 | |
| |
Adp of the SNF | Dec 2, 2024 | |
| |
Adp of the SNF | Jul 31, 2023 | |
| |
Adp of the SNF | Mar 11, 2012 | |
| |
Adp of the SNF | Jan 9, 2023 |
All facility ownership & control disclosures 2
| Facility | Type | Role | Since |
|---|---|---|---|
| Wisconsin Veterans Home at Union Grove |
Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) Operational/Managerial Control Adp of the SNF |
Mar 27, 2006 Mar 27, 2006 Mar 27, 2006 |
| The Wisconsin Veterans Home at Chippewa Falls |
Skilled nursing facility | 5% Or Greater Direct Ownership Interest (100%) Operational/Managerial Control Adp of the SNF |
Oct 1, 2012 Oct 1, 2012 Oct 1, 2012 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20150629001572 | WI | Part a Provider - Skilled Nursing Facility | 1456369826 | Practice locations: King, WI |
| O20150715001743 | WI | Part a Provider - Skilled Nursing Facility | 1456369826 | Practice locations: King, WI |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Skilled Nursing Facility | 314000000X | 2485 | WI | Yes |
Addresses
Primary practice location
N2665 County Road QQ
King, WI 54946
Mailing address
N2665 County Road QQ
King, WI 54946-0600
Phone (715) 258-5586
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 20135000 | Medicaid | WI |
Other names
- The Wisconsin Veterans Home At King
Other providers in King, WI
- Debbie Le Le
- James Alan Lebouef
- Lisa Lebouef
- Cynthia Ann Rendall
- Shiela Jean Schultz
- Wisconsin Veterans Home Phcy
All providers in King, WI · Skilled Nursing 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 Jan 6, 2026. 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.