Hendricks Community Hospital Assn & Retirement Home
Organization Active NPI Medicare Defined Swing Bed Hospital Unit · Hendricks, MN
NPI 1154497527 · NPPES record last updated Sep 13, 2018
Key facts
- NPI
- 1154497527
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Medicare Defined Swing Bed Hospital Unit 275N00000X
- License
- 330907 (MN)
- Legal business name
- HENDRICKS COMMUNITY HOSPITAL ASSN & RETIREMENT HOME
- Practice address
- 503 East Lincoln St
Hendricks, MN 56136-0106 - Phone
- (507) 275-3134
- Fax
- (507) 275-2242
- NPI assigned
- Nov 28, 2006
- Organization subpart
- No
Authorized official
- Name
- Mr. Jeff Gollaher
- Title
- Ceo
- Phone
- (507) 275-3134
Other NPIs with the same Medicare PAC ID 6
Corporate family (same tax ID) 6
Related certifications (CCN) 1
Practitioners 5
-
Brenda R Bullerman, PA-C
-
Kathryn Jo Christensen, NP-C
-
Tabb McCluskey, D.O.
-
Julie A Cameron, C.N.P.
Affiliated clinicians 2
-
Tabb McCluskey, D.O.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MN
Hospital certification: CCN 24Z339
- Legal name
- HENDRICKS COMMUNITY HOSPITAL ASSN & RETIREMENT HOME
- Organization structure
- Corporation · Non-profit
- Enrollment address
- 503 E Lincoln St
Hendricks, MN 56136-9598
All disclosed owners & managing parties 10
| Name | Role | Since | Share |
|---|---|---|---|
| Mark Vaneck |
Corporate Director | Mar 27, 2007 | |
| Dawn Popowski |
Corporate Director | Jan 1, 2019 | |
| Amy Heidi Fier |
Corporate Director |
Aug 25, 2022 | |
| Travis Olsen |
Corporate Officer |
Jan 1, 2025 | |
| W-2 Managing Employee |
Jan 1, 2025 | 100% | |
| Vince Robinson |
Corporate Director | Jul 27, 2005 | |
| James Ness |
Corporate Director | Aug 27, 2015 | |
| Brittany Johnson |
Corporate Director |
Aug 25, 2022 | |
| John Engels |
Corporate Director | Aug 24, 2017 | |
| Allen Molascon |
Corporate Director | Jul 27, 2005 | |
| Heather Shaw |
Corporate Director |
Aug 26, 2023 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20080430000326 | MN | Part a Provider - Critical Access Hospital | 9830127356 | Practice locations: Hendricks, MN |
National Provider Directory
- Tax ID family
- White Family Practice C
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medicare Defined Swing Bed Hospital Unit | 275N00000X | 330907 | MN | Yes |
Addresses
Primary practice location
503 East Lincoln St
Hendricks, MN 56136-0106
Mailing address
PO Box 106
503 East Lincoln St
Hendricks, MN 56136-0106
Phone (507) 275-3134
Other providers in Hendricks, MN
- Kathryn Jo Christensen
- Rolland C Digre
- Hendricks Clinic PA
- Hendricks Community Hospital Assn & Retirement Home
- Hendricks Community Hospital Assn & Retirement Home
- Hendricks Community Hospital Assn & Retirement Home
- Hendricks Community Hospital Assn & Retirement Home
- Hendricks Community Hospital Assn & Retirement Home
- Hendricks Community Hospital Association
- Hendricks Community Hospital Association
All providers in Hendricks, MN · Medicare Defined Swing Bed Hospital Unit in Minnesota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 13, 2018. 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.