NPIMap

Organization Active NPI

Prairie Creek Healthcare, Inc.

Doing business as West Bend Health and Rehabilitation

  • Skilled Nursing Facility
  • West Bend, IA
National Provider Identifier
1184917148
Registry record updated Feb 23, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
PRAIRIE CREEK HEALTHCARE, INC.
Doing business as
West Bend Health and Rehabilitation
Practice address
203 4TH St NW
West Bend, IA 50597-5114
Phone
(515) 887-4071
Fax
(515) 887-3973
NPI assigned
May 24, 2011
Last updated
Feb 23, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 23, 2021

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

Authorized official

Name
Ms. Soon Burnam
Title
Treasurer
Phone
(949) 540-1249

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Assisted Living Facility 310400000X IA
Skilled Nursing Facility 314000000X IA Primary

Addresses

Primary practice location

203 4TH St NW
West Bend, IA 50597-5114

Mailing address

203 4TH St NW
West Bend, IA 50597-5114
Phone (515) 887-4071

Other names 1

  • West Bend Health and Rehabilitation Doing business as

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL https://199.119.81.30:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRResponse_Service Other eSolutions Inc.

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110808000576 IA Part A Provider - Skilled Nursing Facility 6901075969 Practice locations: West Bend, IA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1184917148. Details of each certification follow.

Skilled nursing facility certification: CCN 165444

Legal name
PRAIRIE CREEK HEALTHCARE INC
Doing business as
WEST BEND HEALTH AND REHABILITATION
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Nov 14, 2001
Last certification
May 1, 2025
Beds
45
Ownership / control type
Corporation
Multi-facility organization
Ensign
Most recent change of ownership
Jul 18, 2011
Organization structure
CorporationProprietary
Enrollment address
203 4TH St NW
West Bend, IA 50597-5114
Nursing home name
WEST BEND HEALTH AND REHABILITATION
Affiliated entity
THE ENSIGN GROUP

Care Compare: Nursing home

Medicare Care Compare
Listed as
West Bend Health and RehabilitationCCN 165444 · All quality measures
Overall star rating
4 of 5
Health inspections
3 of 5
Staffing
3 of 5
Quality measures
5 of 5
Type
Medicare and Medicaid
Ownership
For profit - Corporation
Certified
Nov 14, 2001
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
4543.2 residents per day on average
Chain
The Ensign Group342 facilities in the chain

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
16D0384459West Bend Health and Rehabilitation203 Fourth Street NW, West Bend, IA 50597Certificate of waiverAug 31, 2026

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 15

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

NameRoleSinceShare
4TH Street Holdings LLC Organization, San Clemente, CA LLC Adp of the SNF Jul 18, 2011
Brent D Owen Individual Operational/Managerial Control May 1, 2014
Managing Control - Governing BodyMedical Director May 1, 2014
Adp of the SNF Jul 9, 2025
The Ensign Group Inc Organization, San Juan Capistrano, CA Corporation 5% Or Greater Indirect Ownership Interest Jan 30, 2006
Ensign Services Inc Organization, San Juan Capistrano, CA Corporation Adp of the SNF Jun 1, 2011
Ami Sato Individual Corporate OfficerTreasurer Prairie Creek Healthcare Sep 9, 2024
Ctr Partnership LP Organization, San Clemente, CA Adp of the SNF Jul 18, 2011
David Jorgensen Individual Corporate DirectorDirector Prairie Creek Healthcare Jan 1, 2024
Gateway Healthcare LLC Organization, San Juan Capistrano, CA LLC 5% Or Greater Direct Ownership Interest Jul 18, 2011 100%
Caretrust GP LLC Organization, San Clemente, CA LLC Adp of the SNF Jul 18, 2011
Debra K Koenig Individual Corporate OfficerPresident Prairie Creek Healthcare, Jan 1, 2020
Ventura Medstaff, LLC Organization, Omaha, NE Corporation Operational/Managerial Control Jul 18, 2011
Caretrust Reit Inc Organization, San Clemente, CA Corporation Adp of the SNF Jul 18, 2011
Chad Keetch Individual Corporate OfficerSecretary Ensign Services, Inc. Mar 1, 2011
Peter Kleinstreuber Individual Operational/Managerial ControlAdministrator Nov 19, 2019
Managing Control - Governing BodyAdministrator Nov 19, 2019
Adp of the SNF Jul 9, 2025
Soon Burnam Individual Corporate OfficerSecretary Prairie Creek Healthcare Jul 18, 2011
Adp of the SNF Jul 9, 2025

Owners & managing parties with NPI records 1

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

  • Brent David Owen, MD
    • Family Medicine Physician
    • Algona, IA
    • NPI 1063670735

    Adp of the SNF, Managing Control - Governing Body, Operational/Managerial Control

    CMS ownership

Facilities with the same owner 21

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

View all 21

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 6

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": "1306195200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1614038400000",
    "number": "1184917148",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "203 4TH ST NW",
            "city": "WEST BEND",
            "state": "IA",
            "postal_code": "505975114",
            "telephone_number": "515-887-4071",
            "fax_number": "515-887-3973"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "203 4TH ST NW",
            "city": "WEST BEND",
            "state": "IA",
            "postal_code": "505975114",
            "telephone_number": "515-887-4071",
            "fax_number": "515-887-3973"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRAIRIE CREEK HEALTHCARE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-05-24",
        "last_updated": "2021-02-23",
        "certification_date": "2021-02-23",
        "status": "A",
        "authorized_official_last_name": "BURNAM",
        "authorized_official_first_name": "SOON",
        "authorized_official_title_or_position": "TREASURER",
        "authorized_official_telephone_number": "949-540-1249",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "IA",
            "license": null,
            "primary": false
        },
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "IA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://199.119.81.30:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRResponse_Service",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113833.3.1066.1",
            "affiliationName": "eSolutions Inc.",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CSV",
            "address_1": "8215 W 108th Ter",
            "city": "Overland Park",
            "state": "KS",
            "country_code": "US",
            "postal_code": "662101661",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "West Bend Health and Rehabilitation",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "West Bend Health and Rehabilitation",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in West Bend, IA

Sources for this page

Verify at the official NPI Registry.