NPIMap

Organization Active NPI

American Baptist Homes of the Midwest

  • Skilled Nursing Facility
  • Omaha, NE
National Provider Identifier
1073501896
Registry record updated Aug 3, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
264009 Issued in NE
Legal business name
AMERICAN BAPTIST HOMES OF THE MIDWEST
Practice address
2824 North 66TH Ave
Omaha, NE 68104-3928
Phone
(402) 551-8282
Fax
(402) 551-1819
NPI assigned
Oct 6, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 3, 2022

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

Authorized official

Name
Christina R Kotz
Title
Director of Residnet Receivables
Phone
(402) 551-2110

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X 264009 NE Primary

Addresses

Primary practice location

2824 North 66TH Ave
Omaha, NE 68104-3928

Mailing address

2824 North 66TH Ave
Omaha, NE 68104-3928
Phone (402) 551-8282

Other names 1

  • Maple Crest Care Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040421001485 NE Part A Provider - Skilled Nursing Facility 8426966953 Practice locations: Omaha, NE

Skilled nursing facility certification: CCN 285149

Legal name
AMERICAN BAPTIST HOMES OF THE MIDWEST
Doing business as
MAPLE CREST CARE CENTER
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Jun 1, 1994
Last certification
Jul 11, 2024
Beds
175
Ownership / control type
Corporation
Multi-facility organization
American Baptist of the Midwest
Organization structure
CorporationNon-profit
Incorporated
Apr 23, 1987 in MN
Enrollment address
2824 N 66TH Ave
Omaha, NE 68104-3928
Nursing home name
MAPLE CREST HEALTH CENTER
Affiliated entity
AMERICAN BAPTIST HOMES OF THE MIDWEST

Other NPIs with the same Medicare PAC ID 3

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

Care Compare: Nursing home

Medicare Care Compare
Listed as
Maple Crest Health CenterCCN 285149
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
For profit - Corporation
Certified
Jun 1, 1994
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
175150.9 residents per day on average
Chain
American Baptist Homes of the Midwest6 facilities in the chain

Processed by Care Compare on Aug 1, 2026.

National Provider Directory

National Provider Directory
Tax ID family
Tudor Oaks HLTH Ctr14 organizations share this tax ID, including this one

Other organizations with this tax ID 13

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

View all 13

Locations

14850 Scenic Heights Rd
Eden Prairie, MN 55344

Networks

  • devoted network organization-a4751131-f16f-4e82-8f2b-b08e66379a7a

Ownership & related parties

All disclosed owners & managing parties 18

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

NameRoleSinceShare
Ashley Elizabeth Ford Individual Corporate Director Jan 1, 2013
Ruth Ann Neiman Individual Corporate Officer Jan 1, 2021
Christina Kotz Individual W-2 Managing EmployeeDirector of Resident Receivables Aug 1, 2018
Steven C Vanostram Individual Corporate Director Jan 1, 2013
Bruce K Van Der Beek Individual Corporate Officer Jan 1, 2021
James Lee Johnson Individual Corporate Director Jan 1, 2013
Roger Allan Davidson Individual Corporate Officer Jan 1, 2021
Marshall Peters Individual Corporate Director Jan 1, 2013
Ryan Allen Individual Corporate Director Jan 1, 2013
Anne S Wagoner Ford Individual Corporate Director Aug 1, 2018
Dorothy Johnson Individual Corporate Officer Jan 1, 2021
Bruce Randolph Whitaker Individual Corporate Director Jan 1, 2013
Stephanie Nicole Vaughn-Gray Individual Corporate Officer Jan 1, 2021
American Baptist Homes of the Midwest Organization, Eden Prairie, MN Non-profit 5% Or Greater Direct Ownership Interest Jan 19, 2010 100%
George Edward Killian Individual Corporate Director Aug 1, 2018
Phillip Hanson Individual Corporate Director Jan 1, 2013
Lars P Johnson Individual Corporate OfficerCfo Jun 5, 2023
Andrea Blatnik Individual Corporate OfficerVP of Human Resources Jan 1, 2012

Owners & managing parties with NPI records 3

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

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Elm Crest Retirement CommunityHarlan, IA, CCN 165372 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Mar 3, 1967

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Facilities with the same owner 1

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

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

Affiliated clinicians 4

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": "1128556800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1659484800000",
    "number": "1073501896",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2824 NORTH 66TH AVE",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681043928",
            "telephone_number": "402-551-8282",
            "fax_number": "402-551-1819"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2824 NORTH 66TH AVE",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681043928",
            "telephone_number": "402-551-8282",
            "fax_number": "402-551-1819"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AMERICAN BAPTIST HOMES OF THE MIDWEST",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-06",
        "last_updated": "2022-08-03",
        "certification_date": "2022-08-03",
        "status": "A",
        "authorized_official_last_name": "KOTZ",
        "authorized_official_first_name": "CHRISTINA",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "DIRECTOR OF RESIDNET RECEIVABLES",
        "authorized_official_telephone_number": "402-551-2110"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "NE",
            "license": "264009",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Maple Crest Care Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Maple Crest Care Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Omaha, NE

Sources for this page

Verify at the official NPI Registry.