NPIMap

Organization Active NPI

Hendricks Community Hospital Assn & Retirement Home

  • Medicare Defined Swing Bed Hospital Unit
  • Hendricks, MN
National Provider Identifier
1154497527
Registry record updated Sep 13, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medicare Defined Swing Bed Hospital UnitTaxonomy code 275N00000X
License
330907 Issued in 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
Last updated
Sep 13, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 13, 2018

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

Authorized official

Name
Mr. Jeff Gollaher
Title
Ceo
Phone
(507) 275-3134

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Medicare Defined Swing Bed Hospital Unit 275N00000X 330907 MN Primary

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

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080430000326 MN Part A Provider - Critical Access Hospital 9830127356 Practice locations: Hendricks, MN

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1154497527. Details of each certification follow.

Hospital certification: CCN 24Z339

Legal name
HENDRICKS COMMUNITY HOSPITAL ASSN & RETIREMENT HOME
Organization structure
CorporationNon-profit
Enrollment address
503 E Lincoln St
Hendricks, MN 56136-9598
Hospital Swing-Bed Unit

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 6

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

National Provider Directory

National Provider Directory
Tax ID family
Hendricks Community Hospital Association7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

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

Ownership & related parties

All disclosed owners & managing parties 10

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

NameRoleSinceShare
Mark Vaneck Individual Corporate Director Mar 27, 2007
Dawn Popowski Individual Corporate Director Jan 1, 2019
Amy Heidi Fier Individual Corporate DirectorBoard Member Aug 25, 2022
Travis Olsen Individual Corporate OfficerCeo Jan 1, 2025
W-2 Managing EmployeeAd; Jan 1, 2025 100%
Vince Robinson Individual Corporate Director Jul 27, 2005
James Ness Individual Corporate Director Aug 27, 2015
Brittany Johnson Individual Corporate DirectorBoard Member Aug 25, 2022
John Engels Individual Corporate Director Aug 24, 2017
Allen Molascon Individual Corporate Director Jul 27, 2005
Heather Shaw Individual Corporate DirectorDirector Aug 26, 2023

Practitioners & affiliated clinicians

Affiliated clinicians 2

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": "1164672000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1536796800000",
    "number": "1154497527",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 106",
            "address_2": "503 EAST LINCOLN ST",
            "city": "HENDRICKS",
            "state": "MN",
            "postal_code": "561360106",
            "telephone_number": "507-275-3134",
            "fax_number": "507-275-2242"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "503 EAST LINCOLN ST",
            "city": "HENDRICKS",
            "state": "MN",
            "postal_code": "561360106",
            "telephone_number": "507-275-3134",
            "fax_number": "507-275-2242"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HENDRICKS COMMUNITY HOSPITAL ASSN & RETIREMENT HOME",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-28",
        "last_updated": "2018-09-13",
        "status": "A",
        "authorized_official_last_name": "GOLLAHER",
        "authorized_official_first_name": "JEFF",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "507-275-3134",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "275N00000X",
            "taxonomy_group": "",
            "desc": "Medicare Defined Swing Bed Unit",
            "state": "MN",
            "license": "330907",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Hendricks, MN

Sources for this page

Verify at the official NPI Registry.