Lutheran Sunset Home Corporation
Organization Active NPI Skilled Nursing Facility · Grafton, ND
NPI 1164423463 · NPPES record last updated May 6, 2014
Key facts
- NPI
- 1164423463
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Skilled Nursing Facility 314000000X
- License
- 1026A (ND)
- Legal business name
- LUTHERAN SUNSET HOME CORPORATION
- Practice address
- 333 Eastern Ave
Grafton, ND 58237-1233 - Phone
- (701) 352-1901
- Fax
- (701) 352-1926
- NPI assigned
- Aug 9, 2005
- Organization subpart
- No
Authorized official
- Name
- Mr. Jason D Carlson
- Title
- Ceo
- Phone
- (701) 352-1901
Owners & managing parties with NPI records 1
-
Matthew Stephen Viscito, M.D.
Corporate family (same tax ID) 1
Practitioners 4
-
Joel J Johnson, M.D.
-
Jared Marquardt, MD
-
Kristi J Midgarden, M.D.
-
Matthew Stephen Viscito, M.D.
Affiliated clinicians 4
-
Jared Marquardt, MD
-
Kristi J Midgarden, M.D.
-
Jennifer D Shaw, M.D.
-
Matthew Stephen Viscito, M.D.
Medicare Care Compare: Nursing home
- Listed as
- Lutheran Sunset Home
- 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 - Church related
- Certified
- Nov 1, 1978
- Medicare certification status
- Active
- Certified beds
- 87 · 81.8 residents per day on average
- Penalties (3 years)
- 1 · fines totaling $11,057
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in ND
Skilled nursing facility certification: CCN 355084
- Legal name
- LUTHERAN SUNSET HOME CORPORATION
- Doing business as
- LUTHERAN SUNSET HOME
- Certification status
- Active
- Provider type (POS)
- Nursing home – SNF/NF dual certification
- Participating since
- Nov 1, 1978
- Last certification
- Dec 19, 2024
- Beds
- 87
- Ownership / control type
- Church Related
- Organization structure
- Corporation · Non-profit
- Incorporated
- Jul 21, 1949 in ND
- Enrollment address
- 333 Eastern Ave
Grafton, ND 58237-1233 - Nursing home name
- LUTHERAN SUNSET HOME
All disclosed owners & managing parties 9
| Name | Role | Since | Share |
|---|---|---|---|
| Roberta Corrick |
Corporate Director | Mar 22, 2018 | |
| John Dusek |
Corporate Director | Mar 21, 2019 | |
| Trevor Joshua Tompkins |
Corporate Officer |
May 16, 2017 | |
| Operational/Managerial Control | May 16, 2017 | ||
| Adp of the SNF | May 16, 2017 | ||
| Andrew Wysocki |
Corporate Director | Mar 23, 2023 | |
| Brad Nilson |
Corporate Director | Mar 23, 2023 | |
| Kari L Pastorek |
Corporate Director | Mar 22, 2018 | |
| Michael Hanson |
Corporate Director | Mar 23, 2023 | |
| Matthew S Viscito |
Operational/Managerial Control | Feb 1, 2017 | |
| Adp of the SNF | Feb 1, 2017 | ||
| Tammy L Lee |
Corporate Director | Mar 28, 2024 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20050502000737 | ND | Part a Provider - Skilled Nursing Facility | 4981643624 | Practice locations: Grafton, ND |
National Provider Directory
- Tax ID family
- Lutheran Sunset Home
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Assisted Living Facility | 310400000X | AL34 | ND | |
| Skilled Nursing Facility | 314000000X | 1026A | ND | Yes |
Addresses
Primary practice location
333 Eastern Ave
Grafton, ND 58237-1233
Mailing address
333 Eastern Ave
Grafton, ND 58237-1233
Phone (701) 352-1901
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1636 | Other | ND | BC/BS |
| 30016 | Medicaid | ND |
Other names
- Lutheran Sunset Home
Other providers in Grafton, ND
- Alex G Lindell
- Karissa Lindseth
- Summer Linke
- Natalie Lee Lopez
- Averi Ashton Lundebrek
- Lutheran Sunset Home Corporation
- Kimball Anthony Lutovsky
- Heidi Jo Madsen
- Ashley Mathiason
- Jaime Rae Mattson
All providers in Grafton, ND · Skilled Nursing Facility in North Dakota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 6, 2014. 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.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.