NPIMap

Organization Active NPI

DT Woodbine, LLC

  • Skilled Nursing Facility
  • Woodbine, IA
National Provider Identifier
1093390247
Registry record updated Mar 9, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
DT WOODBINE, LLC
Practice address
1109 Normal St
Woodbine, IA 51579-1091
Phone
(712) 647-2010
NPI assigned
Mar 9, 2021
Last updated
Mar 9, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 9, 2021

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

Authorized official

Name
Aaron Kaminer
Title
Manager
Phone
(712) 647-2010

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Assisted Living Facility 310400000X NU
Skilled Nursing Facility 314000000X NU Primary

Addresses

Primary practice location

1109 Normal St
Woodbine, IA 51579-1091

Mailing address

702 S Highway 6
Gretna, NE 68028-7970

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20210512001931 IA Part A Provider - Skilled Nursing Facility 6608285127 Practice locations: Woodbine, IA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1093390247. Details of each certification follow.

Skilled nursing facility certification: CCN 165357

Legal name
DT WOODBINE, LLC
Doing business as
AZRIA HEALTH ROSE VISTA
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Oct 1, 1997
Last certification
Nov 7, 2024
Beds
76
Ownership / control type
Limited Liability Corporation
Organization structure
LLCProprietary
Enrollment address
1109 Normal St
Woodbine, IA 51579-1091
Nursing home name
AZRIA HEALTH ROSE VISTA
Affiliated entity
AZRIA HEALTH

Care Compare: Nursing home

Medicare Care Compare
Listed as
Azria Health Rose VistaCCN 165357 · All quality measures
Overall star rating
1 of 5
Health inspections
2 of 5
Staffing
4 of 5
Quality measures
1 of 5
Type
Medicare and Medicaid
Ownership
For profit - Limited Liability company
Certified
Oct 1, 1997
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
7664.9 residents per day on average
Chain
Azria Health9 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
16D0882971Azria Health Rose Vista1109 Normal Street, Woodbine, IA 51579Certificate of waiverFeb 18, 2028

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 5

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

NameRoleSinceShare
Steven B Hornung Individual 5% Or Greater Indirect Ownership Interest Apr 1, 2021 50%
Corporate OfficerManager Apr 1, 2021
Azria Ventures LLC Organization, Gretna, NE LLC, Holding company, For-profit 5% Or Greater Indirect Ownership Interest Apr 1, 2021 100%
Dovetail Opco Holdings LLC Organization, Gretna, NE LLC, For-profit 5% Or Greater Direct Ownership Interest Apr 1, 2021 100%
Kara Behrendt Individual W-2 Managing EmployeeAdministrator Apr 1, 2021
Aaron Noah Kaminer Individual 5% Or Greater Indirect Ownership Interest Apr 1, 2021 50%
Corporate OfficerManager Apr 1, 2021

Facilities with the same owner 2

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

Practitioners & affiliated clinicians

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": "1615248000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1615248000000",
    "number": "1093390247",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "702 S HIGHWAY 6",
            "city": "GRETNA",
            "state": "NE",
            "postal_code": "680287970"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1109 NORMAL ST",
            "city": "WOODBINE",
            "state": "IA",
            "postal_code": "515791091",
            "telephone_number": "712-647-2010"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DT WOODBINE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-03-09",
        "last_updated": "2021-03-09",
        "certification_date": "2021-03-09",
        "status": "A",
        "authorized_official_last_name": "KAMINER",
        "authorized_official_first_name": "AARON",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "712-647-2010"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Woodbine, IA

Sources for this page

Verify at the official NPI Registry.