STATE OF WISCONSIN — NPI 1366439986 (Licensed Skilled Nursing & Inpatient Post-Acute Rehabilitation Facility (SNF) in KING, WI)

CMS-1500 Box 24J / 33a • NPI

1366439986

Type 2 Organization (Box 32a/33a)

HIPAA NUCC Taxonomy • CMS Code

314000000X (CMS A1[8])

Licensed Skilled Nursing & Inpatient Post-Acute Rehabilitation Facility (SNF)

Box 32 Service Location & ZIP+4

N2665 COUNTY ROAD QQ, KING, WI, 54946

Official NPPES Practice Location

Practice Phone & Referral Fax

(715) 258-5586

Fax: (715) 258-1677

✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR: NPI 1366439986 (STATE OF WISCONSIN) has 0 active federal exclusions across all 84,224 HHS OIG LEIE sanction records (Database Verified: 2026-11-11).

CMS Medicare Order & Referring PECOS Eligibility

Institutional Type-2 NPI facilities enroll via CMS-855A institutional provider agreements rather than individual Order & Referring PECOS.

Official CMS NPPES Credential & Practice Profile

10-Digit NPI Number	`1366439986` (NPI-2 Organization / Facility)
Provider / Legal Name	STATE OF WISCONSIN
Plain-English Specialty	Licensed Skilled Nursing & Inpatient Post-Acute Rehabilitation Facility (SNF) NUCC Code: `314000000X` (Skilled Nursing Facility)
Certifying / Licensing Body	CMS Five-Star Quality Rating System / State Department of Health
Practice Location Address	N2665 COUNTY ROAD QQ, KING, WI, 54946
Practice Telephone / Fax	Tel: (715) 258-5586 \| Fax: (715) 258-1677
Administrative Mailing Address	N2665 COUNTY ROAD QQ, KING, WI, 54946-0600
Enumeration & Last Sync	Enumerated: 2005-09-29 \| CMS Record Updated: 2026-01-06
Authorized Official	TAMMY SERVATIUS (Division of Homes Administrator)

Clinic Location, Accessibility & Directions

📍 Practice Location & Patient Access

N2665 COUNTY ROAD QQ, KING, WI, 54946

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Plain-English Taxonomy & CMS Crosswalk (314000000X)

What Does Taxonomy Code 314000000X Mean?

In the HIPAA National Uniform Claim Committee (NUCC) classification, code 314000000X translates to:
"Licensed Skilled Nursing & Inpatient Post-Acute Rehabilitation Facility (SNF)"

CMS-1500 Medicare Specialty Crosswalk: CMS Code A1[8] (Skilled Nursing Facility)
Certifying / Accrediting Authority: CMS Five-Star Quality Rating System / State Department of Health
Clinical Scope: Inpatient rehabilitation and 24-hour skilled nursing care following major surgery, stroke, or prolonged hospitalization.

Specialty Clinical Procedures & Therapeutic Classes

Standard Scope of Care (STATE OF WISCONSIN)

Typical CPT / Diagnostic Procedures:

24-Hour Skilled Nursing Supervision, Enteral Nutrition & Pressure Ulcer Prevention
Post-Acute Orthopedic, Cardiac & Neurological Inpatient Rehabilitation

Common Therapeutic Classes:

Chronic Disease Maintenance Regimens, Analgesics & Thromboprophylaxis

All Registered NUCC Taxonomies & State Licenses

Taxonomy Code & Plain-English Description	State License & Primary Status
`314000000X` — Skilled Nursing Facility Plain English: Licensed Skilled Nursing & Inpatient Post-Acute Rehabilitation Facility (SNF)	State: WI \| License: `2485` \| Primary: Yes (Primary)

Medical Billing, RCM & Hospital Credentialing Teams:

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STATE OF WISCONSIN (NPI #1366439986)