Kittson Memorial Hospital Association
Organization Active NPI Skilled Nursing Facility · Hallock, MN
NPI 1003847211 · NPPES record last updated Jul 3, 2025
Key facts
- NPI
- 1003847211
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Skilled Nursing Facility 314000000X
- License
- 330778 (MN)
- Legal business name
- KITTSON MEMORIAL HOSPITAL ASSOCIATION
- Practice address
- 1010 S Birch Ave
Hallock, MN 56728-4215 - Phone
- (218) 843-3612
- NPI assigned
- Jul 5, 2006
- Organization subpart
- No
Authorized official
- Name
- Andrea Swenson
- Title
- Ceo
- Phone
- (218) 843-3802
Owners & managing parties with NPI records 1
-
James E Surdy, M.D.
Other NPIs with the same Medicare PAC ID 5
Corporate family (same tax ID) 6
Practitioners 8
-
James E Surdy, M.D.
-
Vanessa Kay Cook, M.D.
-
Julie A. J. Johnson, FNP
-
Karrah Oliver, PA-C
-
Amanda Jean Pinnock, NP-C
-
Heather Lynn Waldal, FNP-C
Affiliated clinicians 1
-
James E Surdy, M.D.
Medicare Care Compare: Nursing home
- Listed as
- Kittson Healthcare
- Overall star rating
- ★★★☆☆ 3 of 5
- Health inspections
- ★★★☆☆ 3 of 5
- Staffing
- ★★★★☆ 4 of 5
- Quality measures
- ★★★★☆ 4 of 5
- Type
- Medicare and Medicaid
- Ownership
- Non profit - Other
- Certified
- Jul 1, 1982
- Certified beds
- 40 · 35.3 residents per day on average
- Penalties (3 years)
- 1 · fines totaling $8,190
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MN
Skilled nursing facility certification: CCN 245247
- Legal name
- KITTSON MEMORIAL HOSPITAL ASSOCIATION
- Certification status
- Active
- Provider type (POS)
- Nursing home – SNF/NF dual certification
- Participating since
- Jul 1, 1982
- Last certification
- May 22, 2024
- Beds
- 40
- Ownership / control type
- Other Nonprofit
- Organization structure
- Corporation · Non-profit
- Incorporated
- Oct 1, 1922 in MN
- Enrollment address
- 1010 S Birch Ave
Hallock, MN 56728-4215 - Nursing home name
- KITTSON HEALTHCARE
All disclosed owners & managing parties 10
| Name | Role | Since | Share |
|---|---|---|---|
| Sandy Wilson |
Managing Control - Governing Body |
Nov 29, 2018 | |
| Hugh Hunt |
Managing Control - Governing Body |
Feb 17, 2017 | |
| James E Surdy |
Operational/Managerial Control | Nov 1, 2016 | |
| Adp of the SNF | Nov 1, 2020 | ||
| Michael Swanson |
Managing Control - Governing Body |
Aug 1, 2022 | |
| Laura Hanson |
Operational/Managerial Control | Nov 13, 2023 | |
| Adp of the SNF | Nov 13, 2023 | ||
| Carlene L Cole |
Operational/Managerial Control | Apr 23, 1990 | |
| Adp of the SNF | Apr 23, 1990 | ||
| Stacy Diamond |
Managing Control - Governing Body |
Feb 26, 2023 | |
| Roland Larter |
Managing Control - Governing Body |
Nov 29, 2018 | |
| Andrea Swenson |
Operational/Managerial Control | Apr 1, 2023 | |
| Adp of the SNF | Apr 1, 2023 | ||
| Kenny Hultgren |
Managing Control - Governing Body |
Feb 23, 2024 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20120110000341 | MN | Part a Provider - Skilled Nursing Facility | 1355251315 | Practice locations: Hallock, MN |
National Provider Directory
- Tax ID family
- Kittson Memorial Hospit
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Skilled Nursing Facility | 314000000X | 330778 | MN | Yes |
Addresses
Primary practice location
1010 S Birch Ave
Hallock, MN 56728-4215
Mailing address
1010 S Birch Ave
Hallock, MN 56728-4215
Phone (218) 843-3612
Other names
- Kittson Memorial Hospital Association
Other providers in Hallock, MN
- Kristin Marie Atwood
- Julie A. J. Johnson
- Kittson Central School District #2171
- Kittson County
- Kittson Dental Clinic PA
- Kittson Memorial Hospital Association
- Kittson Memorial Hospital Association
- Kittson Memorial Hospital Association
- Kittson Memorial Hospital Association
- Kittson Memorial Hospital Association
All providers in Hallock, MN · Skilled Nursing Facility in Minnesota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 3, 2025. 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.