Edgebrook Care Center
Organization Active NPI Skilled Nursing Facility · Edgerton, MN
NPI 1003893447 · NPPES record last updated Dec 28, 2012
Key facts
- NPI
- 1003893447
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Skilled Nursing Facility 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
- Organization subpart
- No
Authorized official
- Name
- John Doughty
- Title
- Administrator
- Phone
- (507) 442-7121
Subparts reporting this organization as parent 1
Corporate family (same tax ID) 1
Facilities with the same owner 106
Practitioners 2
-
Austin Spronk, M.D.
-
Myles F Zephier, D.O.
Affiliated clinicians 5
-
Diane L Kennedy, M.D.
-
Zachary R Nolz, M.D.
-
Austin Spronk, M.D.
-
Jennifer L Thone, MD
-
Myles F Zephier, D.O.
Medicare Care Compare: Nursing home
- Listed as
- Edgebrook Care Center
- 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
- Active
- Certified beds
- 54 · 49.9 residents per day on average
- Chain
- Good Samaritan Society
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 24D0697431 | Edgebrook Care Center | Certificate of waiver | Aug 31, 2026 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MN
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
- Corporation · Non-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
All disclosed owners & managing parties 12
| Name | Role | Since | Share |
|---|---|---|---|
| Shela Gunnink |
Corporate Director |
Jul 1, 2016 | |
| Gordon Dyk |
Corporate Director |
Jul 1, 2016 | |
| The Evangelical Lutheran Good Samaritan Society |
Operational/Managerial Control | Apr 1, 1991 | |
| Michael Redinger |
Contracted Managing Employee |
Apr 3, 2015 | |
| Randy Landhuis |
Corporate Director |
Jul 1, 2016 | |
| Edgebrook Care Center |
Other | Aug 9, 1966 | |
| Eileen Rozebom |
Corporate Director |
Jul 1, 2018 | |
| Lois Schmidt |
Corporate Director |
Jul 1, 2018 | |
| William Sandbulte |
Corporate Director |
Jul 1, 2018 | |
| Ora Bobeldyk |
Corporate Director |
Jul 1, 2017 | |
| Allen Brummel |
Corporate Director |
Jul 1, 2015 | |
| Donna Hanenburg |
Corporate Director |
Jul 1, 2017 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20070425000330 | MN | Part a Provider - Skilled Nursing Facility | 4587769286 | Practice locations: Edgerton, MN |
National Provider Directory
- Tax ID family
- Edgebrook Estates Assisted Living
Locations
505 Trosky Rd W
Edgerton, MN 56128
Phone (507) 442-5080
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Skilled Nursing Facility | 314000000X | Yes | ||
| 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
| Identifier | Type | State | Issuer |
|---|---|---|---|
| NH0481 | Other | MN | UCARE |
| 030824003 | Other | MN | PRIME WEST |
| 7122565 | Other | MN | EVERCARE-MEDICA |
| 9508ED | Other | MN | BCBS |
| 767842800 | Medicaid | MN |
Other providers in Edgerton, MN
- City of Edgerton
- Edgebrook Estates Assisted Living
- Edgerton Publicschool
- Jessica Leighton
- Joni L Luchtenburg
- Pipestone Family Clinic
All providers in Edgerton, 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 Dec 28, 2012. 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.