NPIMap

Organization Active NPI

Luther Haven

  • Skilled Nursing Facility
  • Montevideo, MN
National Provider Identifier
1184629925
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
388169 Issued in MN
Legal business name
LUTHER HAVEN
Practice address
1109 E Highway 7
Montevideo, MN 56265-1711
Phone
(320) 269-6517
Fax
(320) 269-6510
NPI assigned
Jun 17, 2005
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Mr. James Edward Flaherty
Title
Administrator
Phone
(320) 269-6517

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X 388169 MN Primary

Addresses

Primary practice location

1109 E Highway 7
Montevideo, MN 56265-1711

Mailing address

1109 E Highway 7
Montevideo, MN 56265-1711
Phone (320) 269-6517

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20111221000561 MN Part A Provider - Skilled Nursing Facility 5193991198 Practice locations: Montevideo, MN

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1184629925. Details of each certification follow.

Skilled nursing facility certification: CCN 245259

Legal name
LUTHER HAVEN
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Jan 1, 1975
Last certification
Sep 12, 2024
Beds
55
Ownership / control type
Church Related
Organization structure
CorporationNon-profit
Incorporated
Nov 15, 1971 in MN
Enrollment address
1109 E Highway 7
Montevideo, MN 56265-1711
Nursing home name
LUTHER HAVEN

Care Compare: Nursing home

Medicare Care Compare
Listed as
Luther HavenCCN 245259 · All quality measures
Overall star rating
1 of 5
Health inspections
1 of 5
Staffing
4 of 5
Quality measures
3 of 5
Type
Medicare and Medicaid
Ownership
Non profit - Church related
Certified
Jan 1, 1975
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
5550.2 residents per day on average
Penalties (3 years)
3Fines totaling $101,268

Processed by Care Compare on Aug 1, 2026.

National Provider Directory

National Provider Directory

Locations

1109 E Highway 7
Montevideo, MN 56265
Phone (320) 269-6517

Ownership & related parties

All disclosed owners & managing parties 17

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

NameRoleSinceShare
Justin Hughes Individual Corporate Officer Mar 19, 2024
Operational/Managerial Control Jan 9, 2025
Adp of the SNF Jan 24, 2025
Diane Landmark Individual Corporate Director May 1, 2023
Ann M Nordstrom Individual Operational/Managerial Control Jan 9, 2025
Jason Kurtzbien Individual Corporate DirectorBoard Member May 1, 2022
Sue Winter Individual Corporate Director May 1, 2024
Dynamic Staffing Solutions Organization, Brooklyn Center, MN Medical staffing company Operational/Managerial Control Jan 9, 2025
Adp of the SNF Jan 24, 2025
Marie Eckberg Individual Corporate Director May 1, 2024
Kim Kvam Individual Corporate DirectorBoard Member May 1, 2021
Kelly Snell Individual Corporate Director May 1, 2023
Wipfli LLP Organization, Wausau, WI Consulting firm Operational/Managerial Control Jan 20, 2025
Adp of the SNF Jan 24, 2025
Diane Sachariason Individual Corporate DirectorBoard Member May 1, 2022
Paul Dezeeuw Individual Corporate Director May 1, 2024
All Temporaries Midwest, Inc. Organization, Columbia Heights, MN Medical staffing company Operational/Managerial Control Jan 9, 2025
Adp of the SNF Jan 24, 2025
Grape Tree Medical Staffing LLC Organization, Milford, IA Medical staffing company Operational/Managerial Control Jan 20, 2025
Adp of the SNF Jan 24, 2025
Kathy Tammen Individual Corporate DirectorBoard Member May 1, 2022
Shelly Bednar Individual Corporate DirectorBoard Member May 1, 2019
Nicholas Krueger Individual Operational/Managerial Control Jan 9, 2025
Adp of the SNF Jan 24, 2025

Owners & managing parties with NPI records 1

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

Facilities with the same owner 69

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

View all 69

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

Affiliated clinicians 8

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": "1118966400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1184629925",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1109 E HIGHWAY 7",
            "city": "MONTEVIDEO",
            "state": "MN",
            "postal_code": "562651711",
            "telephone_number": "320-269-6517",
            "fax_number": "320-269-6510"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1109 E HIGHWAY 7",
            "city": "MONTEVIDEO",
            "state": "MN",
            "postal_code": "562651711",
            "telephone_number": "320-269-6517",
            "fax_number": "320-269-6510"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LUTHER HAVEN",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-06-17",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "FLAHERTY",
        "authorized_official_first_name": "JAMES",
        "authorized_official_middle_name": "EDWARD",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "320-269-6517",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "MN",
            "license": "388169",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Montevideo, MN

Sources for this page

Verify at the official NPI Registry.