NPIMap

Organization Active NPI

Edgebrook Care Center

  • Skilled Nursing Facility
  • Edgerton, MN
National Provider Identifier
1003893447
Registry record updated Dec 28, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
EDGEBROOK CARE CENTER
Practice address
505 W Trosky Rd
Edgerton, MN 56128-2748
Phone
(507) 442-7121
Fax
(507) 442-3952
NPI assigned
Dec 28, 2005
Last updated
Dec 28, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 28, 2012

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

Authorized official

Name
John Doughty
Title
Administrator
Phone
(507) 442-7121

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X Primary
Nursing Facility Supplies (DME) 332BN1400X
Parenteral & Enteral Nutrition Supplies (DME) 332BP3500X

Addresses

Primary practice location

505 W Trosky Rd
Edgerton, MN 56128-2748

Mailing address

505 W Trosky Rd
Edgerton, MN 56128-2748
Phone (507) 442-7121

Other identifiers 5

IdentifierTypeStateIssuer
9508EDOtherMNBCBS
7122565OtherMNEVERCARE-MEDICA
NH0481OtherMNUCARE
030824003OtherMNPRIME WEST
767842800MedicaidMN

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070425000330 MN Part A Provider - Skilled Nursing Facility 4587769286 Practice locations: Edgerton, MN

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1003893447. Details of each certification follow.

Skilled nursing facility certification: CCN 245560

Legal name
EDGEBROOK CARE CENTER
Doing business as
EDGEBROOK CARE CENTER
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Jun 1, 1991
Last certification
Oct 15, 2024
Beds
54
Ownership / control type
Nonprofit Corporation
Organization structure
CorporationNon-profit
Incorporated
Aug 9, 1966 in MN
Enrollment address
505 Trosky Rd W
Edgerton, MN 56128-2748
Nursing home name
EDGEBROOK CARE CENTER
Affiliated entity
GOOD SAMARITAN SOCIETY

Care Compare: Nursing home

Medicare Care Compare
Listed as
Edgebrook Care CenterCCN 245560 · All quality measures
Overall star rating
1 of 5
Health inspections
2 of 5
Staffing
1 of 5
Quality measures
3 of 5
Type
Medicare and Medicaid
Ownership
Non profit - Corporation
Certified
Jun 1, 1991
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
5449.9 residents per day on average
Chain
Good Samaritan Society92 facilities in the chain

Processed by Care Compare on Aug 1, 2026.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
24D0697431Edgebrook Care Center505 Trosky Rd West, Edgerton, MN 56128Certificate of waiverAug 31, 2026

National Provider Directory

National Provider Directory
Tax ID family
Edgebrook Care Center2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Locations

505 Trosky Rd W
Edgerton, MN 56128
Phone (507) 442-5080

Ownership & related parties

All disclosed owners & managing parties 12

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

NameRoleSinceShare
Shela Gunnink Individual Corporate DirectorBoard Member Jul 1, 2016
Gordon Dyk Individual Corporate DirectorBoard Member Jul 1, 2016
The Evangelical Lutheran Good Samaritan Society Organization, Sioux Falls, SD Non-profit Operational/Managerial Control Apr 1, 1991
Michael Redinger Individual Contracted Managing EmployeeAdministrator Apr 3, 2015
Randy Landhuis Individual Corporate DirectorBoard Member Jul 1, 2016
Edgebrook Care Center Organization, Edgerton, MN Non-profit Other Aug 9, 1966
Eileen Rozebom Individual Corporate DirectorBoard Member Jul 1, 2018
Lois Schmidt Individual Corporate DirectorBoard Member Jul 1, 2018
William Sandbulte Individual Corporate DirectorBoard Member Jul 1, 2018
Ora Bobeldyk Individual Corporate DirectorBoard Member Jul 1, 2017
Allen Brummel Individual Corporate DirectorBoard Member Jul 1, 2015
Donna Hanenburg Individual Corporate DirectorBoard Member Jul 1, 2017

Facilities with the same owner 106

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

View all 106

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

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 5

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": "1135728000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1356652800000",
    "number": "1003893447",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "505 W TROSKY RD",
            "city": "EDGERTON",
            "state": "MN",
            "postal_code": "561282748",
            "telephone_number": "507-442-7121",
            "fax_number": "507-442-3952"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "505 W TROSKY RD",
            "city": "EDGERTON",
            "state": "MN",
            "postal_code": "561282748",
            "telephone_number": "507-442-7121",
            "fax_number": "507-442-3952"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EDGEBROOK CARE CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-12-28",
        "last_updated": "2012-12-28",
        "status": "A",
        "authorized_official_last_name": "DOUGHTY",
        "authorized_official_first_name": "JOHN",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "507-442-7121"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "332BN1400X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Nursing Facility Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "332BP3500X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Parenteral & Enteral Nutrition",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "9508ED",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "EVERCARE-MEDICA",
            "identifier": "7122565",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UCARE",
            "identifier": "NH0481",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PRIME WEST",
            "identifier": "030824003",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "767842800",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Edgerton, MN

Sources for this page

Verify at the official NPI Registry.