NPIMap

Organization Active NPI

Methodist Manor Retirement Community

  • Nursing Facility/Intermediate Care Facility
  • Storm Lake, IA
National Provider Identifier
1184709115
Registry record updated Apr 19, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nursing Facility/Intermediate Care FacilityTaxonomy code 313M00000X
License
110001 Issued in IA
Legal business name
METHODIST MANOR RETIREMENT COMMUNITY
Practice address
1206 W 4TH St
Storm Lake, IA 50588-3002
Phone
(712) 732-1120
Fax
(712) 732-3406
NPI assigned
Oct 26, 2006
Last updated
Apr 19, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 19, 2012

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

Authorized official

Name
Nicholas Landgraf
Title
Director of Finance
Phone
(712) 732-1120

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nursing Facility/Intermediate Care Facility 313M00000X 110001 IA Primary

Addresses

Primary practice location

1206 W 4TH St
Storm Lake, IA 50588-3002

Mailing address

1206 W 4TH St
Storm Lake, IA 50588-3002
Phone (712) 732-1120

Other identifiers 1

IdentifierTypeStateIssuer
0802686MedicaidIA

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20091113000105 IA Part A Provider - Skilled Nursing Facility 4183762057 Practice locations: Storm Lake, IA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1184709115. Details of each certification follow.

Skilled nursing facility certification: CCN 165359

Legal name
METHODIST MANOR RETIREMENT COMMUNITY
Doing business as
METHODIST MANOR RETIREMENT COMMUNITY
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Sep 1, 1997
Last certification
Mar 27, 2025
Beds
93
Ownership / control type
Nonprofit Corporation
Organization structure
CorporationNon-profit
Enrollment address
1206 W 4TH St
Storm Lake, IA 50588-3002
Nursing home name
METHODIST MANOR RETIREMENT COMMUNITY

Care Compare: Nursing home

Medicare Care Compare
Listed as
Methodist Manor Retirement CommunityCCN 165359 · All quality measures
Overall star rating
4 of 5
Health inspections
3 of 5
Staffing
5 of 5
Quality measures
4 of 5
Type
Medicare and Medicaid
Ownership
Non profit - Corporation
Certified
Sep 1, 1997
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
9386.5 residents per day on average
Penalties (3 years)
1Fines totaling $0

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
16D0713693Methodist Manor1206 W Fourth Street, Storm Lake, IA 50588Certificate of waiverAug 31, 2026

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 21

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

NameRoleSinceShare
Carl Turner Individual Corporate DirectorDirector Jan 1, 2022 8.3%
Debra Dehaan Individual Corporate Director Jan 1, 2020 8.3%
Robert Bennett Individual Corporate OfficerVice Chair Jan 1, 2023 8.3%
Corporate DirectorDirector Jan 1, 2006
Clark Fort Individual Corporate DirectorDirector Jan 1, 2023 8.3%
Jason a Huisenga Individual Operational/Managerial Control Jan 1, 2024
Adp of the SNF Jan 1, 2024
Ronald Stevenson Individual Operational/Managerial Control Aug 19, 2017
Adp of the SNF Aug 19, 2017
Scott Schuelke Individual Corporate OfficerBoard Chair Jan 1, 2023 8.3%
Corporate Director Jan 1, 2008
Tina Shannon Individual Operational/Managerial Control Sep 10, 1990
Adp of the SNF Sep 10, 1990
David Archer Individual Corporate DirectorDirector Jan 1, 2017 8.3%
Joleen Dentlinger Individual Corporate OfficerSecretary Jan 1, 2023 8.3%
Corporate Director Jan 1, 2002
Kiboko Kiboko Individual Corporate DirectorDirector Sep 1, 2020 8.3%
Steven Campbell Individual Corporate OfficerTreasurer Jan 1, 2023 8.3%
Corporate DirectorDirector Jan 1, 2015
Luz Gonzalex Individual Operational/Managerial Control Oct 7, 1999
Adp of the SNF Oct 7, 1999
David Friedrich Individual Corporate Director Jan 1, 2003
Jennifer Hecht Individual Corporate DirectorDirector Jan 1, 2012
Allen Patten Individual Corporate DirectorDirector Jan 1, 2022 8.3%
David Peterson Individual Operational/Managerial Control Feb 9, 1999
Adp of the SNF Feb 9, 1999
Williams & Company PC Organization, Sioux City, IA Operational/Managerial Control Jan 1, 2024
Adp of the SNF Jul 17, 2025
LTC Accounting Services, LLC Organization, Urbandale, IA LLC, Consulting firm, For-profit Operational/Managerial Control Jan 1, 2024
Adp of the SNF Jul 17, 2025
Generations Senior Management, LLC Organization, Urbandale, IA LLC, Management services company, For-profit Operational/Managerial Control Jan 1, 2024
Adp of the SNF Jul 17, 2025
Nicholas J Landgraf Individual Operational/Managerial Control Jan 27, 2012
Adp of the SNF Jan 27, 2012

Owners & managing parties with NPI records 2

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

Facilities with the same owner 7

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

Practitioners & affiliated clinicians

Practitioners 1

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 9

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": "1161820800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1334793600000",
    "number": "1184709115",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1206 W 4TH ST",
            "city": "STORM LAKE",
            "state": "IA",
            "postal_code": "505883002",
            "telephone_number": "712-732-1120",
            "fax_number": "712-732-3406"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1206 W 4TH ST",
            "city": "STORM LAKE",
            "state": "IA",
            "postal_code": "505883002",
            "telephone_number": "712-732-1120",
            "fax_number": "712-732-3406"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "METHODIST MANOR RETIREMENT COMMUNITY",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-26",
        "last_updated": "2012-04-19",
        "status": "A",
        "authorized_official_last_name": "LANDGRAF",
        "authorized_official_first_name": "NICHOLAS",
        "authorized_official_title_or_position": "DIRECTOR OF FINANCE",
        "authorized_official_telephone_number": "712-732-1120"
    },
    "taxonomies": [
        {
            "code": "313M00000X",
            "taxonomy_group": "",
            "desc": "Nursing Facility/Intermediate Care Facility",
            "state": "IA",
            "license": "110001",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0802686",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Storm Lake, IA

Sources for this page

Verify at the official NPI Registry.