State of Wisconsin

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

2485 Issued in WI

Legal business name

STATE OF WISCONSIN

Doing business as

The Wisconsin Veterans Home At King

Practice address

N2665 County Road QQ
King, WI 54946

Phone

(715) 258-5586

Fax

(715) 258-1677

NPI assigned

Sep 29, 2005

Last updated

Jan 6, 2026By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Tammy Servatius

Title

Division of Homes Administrator

Phone

(715) 258-4251

Specialties & licenses 1

Addresses

Other names 1

• The Wisconsin Veterans Home At King Doing business as

Medicare fee-for-service enrollment

Enrolled in WI2 enrollments

Enrollment records 2

NPI to CCN mapping 2

The Medicare certification numbers (CCNs) connected to NPI 1366439986. Details of each certification follow.

• CCN 525718 Skilled nursing facility · Active · Details
• CCN 525719 Skilled nursing facility · Active · Details

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

GovernmentNon-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

GovernmentNon-profit

Enrollment address

N2665 County Road QQ
King, WI 54946-0601

Nursing home name

WI VETERANS HM AINSWORTH HALL

Other NPIs with the same Medicare PAC ID 2

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

• State of Wisconsin

  dba WI Veterans Home Union Grove

  • Skilled Nursing Facility
  • Union Grove, WI
  • NPI 1225152861

  1456369826

  Same PAC ID
• State of Wisconsin

  • Skilled Nursing Facility
  • Chippewa Falls, WI
  • NPI 1558615815

  1456369826

  Same PAC ID

Listed as

WI Veterans Hm Ainsworth HallCCN 525719 · All quality measures

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

ActiveFrom the Provider of Services file

Certified beds

19898.6 residents per day on average

Processed by Care Compare on Aug 1, 2026.

Listed as

WI Veterans Home Moses HallCCN 525718 · All quality measures

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

ActiveFrom the Provider of Services file

Certified beds

192184.1 residents per day on average

Penalties (3 years)

1Fines totaling $23,520

Processed by Care Compare on Aug 1, 2026.

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

• State of Wisconsin

  • Skilled Nursing Facility
  • Chippewa Falls, WI
  • NPI 1558615815

  Member Of

  NPD member

Locations

All disclosed owners & managing parties 30

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

Owners & managing parties with NPI records 3

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

• Thanmayi Kaza, MD

  • Family Medicine Physician
  • Appleton, WI
  • NPI 1053842492

  Adp of the SNF, Operational/Managerial Control

  CMS ownership
• State of Wisconsin

  dba WI Veterans Home Union Grove

  • Skilled Nursing Facility
  • Union Grove, WI
  • NPI 1225152861

  5% Or Greater Direct Ownership Interest, Adp of the SNF, Operational/Managerial Control

  CMS ownership
• State of Wisconsin

  • Skilled Nursing Facility
  • Chippewa Falls, WI
  • NPI 1558615815

  5% Or Greater Direct Ownership Interest, Adp of the SNF, Operational/Managerial Control

  CMS ownership

All facility ownership & control disclosures 2

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

Owned or controlled facilities with NPI records 2

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

• State of Wisconsin

  dba WI Veterans Home Union Grove

  • Skilled Nursing Facility
  • Union Grove, WI
  • NPI 1225152861

  5% Or Greater Direct Ownership Interest, Adp of the SNF, Operational/Managerial Control

  CMS ownership
• State of Wisconsin

  • Skilled Nursing Facility
  • Chippewa Falls, WI
  • NPI 1558615815

  5% Or Greater Direct Ownership Interest, Adp of the SNF, Operational/Managerial Control

  CMS ownership

Facilities with the same owner 2

Facilities that share an organizational owner with 5% or greater ownership or operational control.

• State of Wisconsin

  dba WI Veterans Home Union Grove

  • Skilled Nursing Facility
  • Union Grove, WI
  • NPI 1225152861

  State of Wisconsin

  CMS ownership
• State of Wisconsin

  • Skilled Nursing Facility
  • Chippewa Falls, WI
  • NPI 1558615815

  State of Wisconsin

  CMS ownership

Affiliated clinicians 6

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

• Angela Kaye Amos, MD

  • Family Medicine Physician
  • Waupaca, WI
  • NPI 1295363554

  Nursing home

  Care Compare affiliation
• Trevor D Argall, MD, MS

  • Family Medicine Physician
  • Waupaca, WI
  • NPI 1467915942

  Nursing home

  Care Compare affiliation
• Amy N Mandeville

  • Family Medicine Physician
  • Waupaca, WI
  • NPI 1225478126

  Nursing home

  Care Compare affiliation
• Kelly Pucillo, MD

  • Family Medicine Physician
  • Waupaca, WI
  • NPI 1548200595

  Nursing home

  Care Compare affiliation
• Robert William Sedlacek, M.D.

  • Family Medicine Physician
  • Waupaca, WI
  • NPI 1003072687

  Nursing home

  Care Compare affiliation
• James P Spencer, MD

  • Family Medicine Physician
  • Waupaca, WI
  • NPI 1457619348

  Nursing home

  Care Compare affiliation

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

{
    "created_epoch": "1127952000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1767657600000",
    "number": "1366439986",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "N2665 COUNTY ROAD QQ",
            "city": "KING",
            "state": "WI",
            "postal_code": "549460600",
            "telephone_number": "715-258-5586",
            "fax_number": "715-258-1677"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "N2665 COUNTY ROAD QQ",
            "city": "KING",
            "state": "WI",
            "postal_code": "54946",
            "telephone_number": "715-258-5586",
            "fax_number": "715-258-1677"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STATE OF WISCONSIN",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-09-29",
        "last_updated": "2026-01-06",
        "certification_date": "2026-01-06",
        "status": "A",
        "authorized_official_last_name": "SERVATIUS",
        "authorized_official_first_name": "TAMMY",
        "authorized_official_title_or_position": "DIVISION OF HOMES ADMINISTRATOR",
        "authorized_official_telephone_number": "715-258-4251"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "WI",
            "license": "2485",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The Wisconsin Veterans Home At King",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "The Wisconsin Veterans Home At King",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Debbie Le Le, LPN, PHARMACY TECH
• James Alan Lebouef, DDS
• Lisa Lebouef, SLP
• Cynthia Ann Rendall, APNP
• Shiela Jean Schultz, FNP
• Wisconsin Veterans Home Phcy (Wisconsin Veterans Home Pharmacy)

• Skilled Nursing Facility in King, WI
• Providers in King, 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 Jan 6, 2026; 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.