NPIMap

Organization Active NPI

Presbyterian Homes of North Oaks Inc,

  • Skilled Nursing Facility
  • North Oaks, MN
National Provider Identifier
1013040112
Registry record updated Aug 26, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 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
Last updated
Aug 26, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 26, 2026

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

Authorized official

Name
Jon Tranby
Title
Director
Phone
(651) 631-6102

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X Primary

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 names 1

  • Waverly Gardens Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110606000335 MN Part A Provider - Skilled Nursing Facility 8022022748 Practice locations: North Oaks, MN

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1013040112. Details of each certification follow.

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
CorporationNon-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

Care Compare: Nursing home

Medicare Care Compare
Listed as
Waverly GardensCCN 245613 · All quality measures
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
ActiveFrom the Provider of Services file
Certified beds
6057.4 residents per day on average
Chain
Presbyterian Homes & Services21 facilities in the chain
Abuse citation
Cited for abuse (Care Compare abuse icon)
Penalties (3 years)
1Fines totaling $113,312

Processed by Care Compare on Aug 1, 2026.

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 9

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

NameRoleSinceShare
Computershare Corporate Trust Company, NA Organization, Saint Paul, MN Corporation, Financial institution, For-profit 5% Or Greater Mortgage Interest Jul 1, 2024 75%
5% Or Greater Security Interest Jul 1, 2024 75%
Mark T Meyer Individual Corporate OfficerChief Financial Officer Mar 30, 2001 50%
Operational/Managerial Control Mar 11, 2011
Adp of the SNF Mar 11, 2011
Mark a Pederson Individual Corporate DirectorMember of Board of Directors Jan 1, 2023 33%
Jane C Pederson Individual Operational/Managerial Control Apr 1, 2021
Adp of the SNF Apr 1, 2021
Jonathan David Fletcher Individual Corporate OfficerCeo Feb 1, 2025 50%
Corporate DirectorMember of Board of Directors Feb 1, 2025 33%
Operational/Managerial Control Feb 1, 2025
Adp of the SNF Feb 1, 2025
PHS Management, LLC Organization, Roseville, MN LLC, Management services company, Non-profit, Chain home office Operational/Managerial Control Mar 11, 2011 100%
Adp of the SNF Feb 17, 2026
Heidi a Peterson Individual Corporate DirectorMember of Board of Directors Jan 1, 2023 33%
Operational/Managerial Control Jan 1, 2023
Adp of the SNF Jan 1, 2023
Katherine a Sammon Individual Operational/Managerial Control Nov 21, 2022
Adp of the SNF Nov 21, 2022
Presbyterian Homes and Services Organization, Roseville, MN Corporation, Non-profit 5% Or Greater Direct Ownership Interest Mar 17, 2020 100%

Owners & managing parties with NPI records 2

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

Facilities with the same owner 22

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

View all 22

Practitioners & affiliated clinicians

Practitioners 1

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": "1173830400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1787702400000",
    "number": "1013040112",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5919 CENTERVILLE RD",
            "city": "NORTH OAKS",
            "state": "MN",
            "postal_code": "551276821",
            "telephone_number": "651-631-6432",
            "fax_number": "651-631-6122"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5919 CENTERVILLE RD",
            "city": "NORTH OAKS",
            "state": "MN",
            "postal_code": "551276821",
            "telephone_number": "651-765-4000",
            "fax_number": "651-765-4001"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRESBYTERIAN HOMES OF NORTH OAKS INC,",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-14",
        "last_updated": "2026-08-26",
        "certification_date": "2026-08-26",
        "status": "A",
        "authorized_official_last_name": "TRANBY",
        "authorized_official_first_name": "JON",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "651-631-6102"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Waverly Gardens",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in North Oaks, MN

Sources for this page

Verify at the official NPI Registry.