Presbyterian Homes of North Oaks Inc,
Organization Active NPI Skilled Nursing Facility · North Oaks, MN
NPI 1013040112 · NPPES record last updated Aug 26, 2026
Key facts
- NPI
- 1013040112
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Skilled Nursing Facility 314000000X
- Legal business name
- PRESBYTERIAN HOMES OF NORTH OAKS INC,
- Practice address
- 5919 Centerville Rd
North Oaks, MN 55127-6821 - Phone
- (651) 765-4000
- Fax
- (651) 765-4001
- NPI assigned
- Mar 14, 2007
- Organization subpart
- No
Authorized official
- Name
- Jon Tranby
- Title
- Director
- Phone
- (651) 631-6102
Owners & managing parties with NPI records 2
-
Jane Carol Pederson, M.D.
Member of 1
Facilities with the same owner 22
Practitioners 1
-
Lissa N Chipeco, MD
Affiliated clinicians 1
-
Lissa N Chipeco, MD
Medicare Care Compare: Nursing home
- Listed as
- Waverly Gardens
- Overall star rating
- ★★★☆☆ 3 of 5
- Health inspections
- ★★☆☆☆ 2 of 5
- Staffing
- ★★★★★ 5 of 5
- Quality measures
- ★★☆☆☆ 2 of 5
- Type
- Medicare and Medicaid
- Ownership
- Non profit - Corporation
- Certified
- Aug 2, 2006
- Medicare certification status
- Active
- Certified beds
- 60 · 57.4 residents per day on average
- Chain
- Presbyterian Homes & Services
- Abuse citation
- Cited for abuse (Care Compare abuse icon)
- Penalties (3 years)
- 1 · fines totaling $113,312
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MN
Skilled nursing facility certification: CCN 245613
- Legal name
- PRESBYTERIAN HOMES OF NORTH OAKS INC,
- Doing business as
- WAVERLY GARDENS
- Certification status
- Active
- Provider type (POS)
- Nursing home – SNF/NF dual certification
- Participating since
- Aug 2, 2006
- Last certification
- Sep 26, 2024
- Beds
- 60
- Ownership / control type
- Nonprofit Corporation
- Multi-facility organization
- Presbyterian Homes and Services
- Organization structure
- Corporation · Non-profit
- Incorporated
- Mar 30, 2001 in MN
- Enrollment address
- 5919 Centerville Rd
North Oaks, MN 55127-6821 - Nursing home name
- WAVERLY GARDENS
- Affiliated entity
- PRESBYTERIAN HOMES & SERVICES
All disclosed owners & managing parties 9
| Name | Role | Since | Share |
|---|---|---|---|
| Computershare Corporate Trust Company, NA |
5% Or Greater Mortgage Interest | Jul 1, 2024 | 75% |
| 5% Or Greater Security Interest | Jul 1, 2024 | 75% | |
| Mark T Meyer |
Corporate Officer |
Mar 30, 2001 | 50% |
| Operational/Managerial Control | Mar 11, 2011 | ||
| Adp of the SNF | Mar 11, 2011 | ||
| Mark a Pederson |
Corporate Director |
Jan 1, 2023 | 33% |
| Jane C Pederson |
Operational/Managerial Control | Apr 1, 2021 | |
| Adp of the SNF | Apr 1, 2021 | ||
| Jonathan David Fletcher |
Corporate Officer |
Feb 1, 2025 | 50% |
| Corporate Director |
Feb 1, 2025 | 33% | |
| Operational/Managerial Control | Feb 1, 2025 | ||
| Adp of the SNF | Feb 1, 2025 | ||
| PHS Management, LLC |
Operational/Managerial Control | Mar 11, 2011 | 100% |
| Adp of the SNF | Feb 17, 2026 | ||
| Heidi a Peterson |
Corporate Director |
Jan 1, 2023 | 33% |
| Operational/Managerial Control | Jan 1, 2023 | ||
| Adp of the SNF | Jan 1, 2023 | ||
| Katherine a Sammon |
Operational/Managerial Control | Nov 21, 2022 | |
| Adp of the SNF | Nov 21, 2022 | ||
| Presbyterian Homes and Services |
5% Or Greater Direct Ownership Interest | Mar 17, 2020 | 100% |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20110606000335 | MN | Part a Provider - Skilled Nursing Facility | 8022022748 | Practice locations: North Oaks, MN |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Skilled Nursing Facility | 314000000X | Yes |
Addresses
Primary practice location
5919 Centerville Rd
North Oaks, MN 55127-6821
Mailing address
5919 Centerville Rd
North Oaks, MN 55127-6821
Phone (651) 631-6432
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| NH0581 | Other | MN | UCARE |
| 836967000 | Medicaid | MN | |
| 7100507 | Other | MEDICA |
Other names
- Waverly Gardens
Other providers in North Oaks, MN
- Kristin Neafus
- Thomas Erik Neafus
- North Metro Dermatology PLLC
- Jacqueline Sue Pal
- Marilynn Poss
- Presbyterian Homes of North Oaks, Inc.
- Prime Chiropractic & Rehab Center
- Prime Family Medical Clinic
- Anudeep K Rahil
- Brittany Raymond
All providers in North Oaks, 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 Aug 26, 2026. 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.