NPIMap

Organization Active NPI

Kittson Memorial Hospital Association

  • Skilled Nursing Facility
  • Hallock, MN
National Provider Identifier
1003847211
Registry record updated Jul 3, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
330778 Issued in MN
Legal business name
KITTSON MEMORIAL HOSPITAL ASSOCIATION
Doing business as
Kittson Memorial Hospital Association
Practice address
1010 S Birch Ave
Hallock, MN 56728-4215
Phone
(218) 843-3612
NPI assigned
Jul 5, 2006
Last updated
Jul 3, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 3, 2025

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

Authorized official

Name
Andrea Swenson
Title
Ceo
Phone
(218) 843-3802

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X 330778 MN Primary

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 1

  • Kittson Memorial Hospital Association Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120110000341 MN Part A Provider - Skilled Nursing Facility 1355251315 Practice locations: Hallock, MN

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1003847211. Details of each certification follow.

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
CorporationNon-profit
Incorporated
Oct 1, 1922 in MN
Enrollment address
1010 S Birch Ave
Hallock, MN 56728-4215
Nursing home name
KITTSON HEALTHCARE

Other NPIs with the same Medicare PAC ID 5

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

Care Compare: Nursing home

Medicare Care Compare
Listed as
Kittson HealthcareCCN 245247 · All quality measures
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
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
4035.3 residents per day on average
Penalties (3 years)
1Fines totaling $8,190

Processed by Care Compare on Aug 1, 2026.

National Provider Directory

National Provider Directory
Tax ID family
Northwestern MN HLTH CL7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 10

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

NameRoleSinceShare
Sandy Wilson Individual Managing Control - Governing BodyBoard Member Nov 29, 2018
Hugh Hunt Individual Managing Control - Governing BodyBoard Member Feb 17, 2017
James E Surdy Individual Operational/Managerial Control Nov 1, 2016
Adp of the SNF Nov 1, 2020
Michael Swanson Individual Managing Control - Governing BodyBoard Member Aug 1, 2022
Laura Hanson Individual Operational/Managerial Control Nov 13, 2023
Adp of the SNF Nov 13, 2023
Carlene L Cole Individual Operational/Managerial Control Apr 23, 1990
Adp of the SNF Apr 23, 1990
Stacy Diamond Individual Managing Control - Governing BodyDirector Feb 26, 2023
Roland Larter Individual Managing Control - Governing BodyBoard Member Nov 29, 2018
Andrea Swenson Individual Operational/Managerial Control Apr 1, 2023
Adp of the SNF Apr 1, 2023
Kenny Hultgren Individual Managing Control - Governing BodyBoard Member Feb 23, 2024

Owners & managing parties with NPI records 1

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

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

Affiliated clinicians 1

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

NPI Registry JSON

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

{
    "created_epoch": "1152057600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1751500800000",
    "number": "1003847211",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1010 S BIRCH AVE",
            "city": "HALLOCK",
            "state": "MN",
            "postal_code": "567284215",
            "telephone_number": "218-843-3612"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1010 S BIRCH AVE",
            "city": "HALLOCK",
            "state": "MN",
            "postal_code": "567284215",
            "telephone_number": "218-843-3612"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KITTSON MEMORIAL HOSPITAL ASSOCIATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-05",
        "last_updated": "2025-07-03",
        "certification_date": "2025-07-03",
        "status": "A",
        "authorized_official_last_name": "SWENSON",
        "authorized_official_first_name": "ANDREA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "218-843-3802"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "MN",
            "license": "330778",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Kittson Memorial Hospital Association",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Kittson Memorial Hospital Association",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Hallock, MN

Sources for this page

Verify at the official NPI Registry.