Active NPI
Thomas Rest Haven
- Nursing Facility/Intermediate Care Facility
- Coon Rapids, IA
National Provider Identifier
1215919949
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nursing Facility/Intermediate Care Facility
- License
- 140430
- Legal business name
- THOMAS REST HAVEN
- Practice address
- 217 Main St
Coon Rapids, IA 50058-1605 - Phone
- (712) 999-2253
- Fax
- (712) 999-5669
- NPI assigned
- Nov 17, 2005
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mary Jane Venteicher
- Title
- Administrator
- Phone
- (712) 999-2253
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Rehabilitation Clinic/Center | 261QR0400X | 140430 | IA | |
| Nursing Facility/Intermediate Care Facility | 313M00000X | 140430 | IA | Primary |
Addresses
Primary practice location
217 Main St
Coon Rapids, IA 50058-1605
Mailing address
217 Main St
Coon Rapids, IA 50058-1605
Phone (712) 999-2253
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 65358 | Other | IA | WELLMARK |
| 0803973 | Medicaid | IA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IA
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20120110000765 | IA | Part A Provider - Skilled Nursing Facility | 7113835414 | Practice locations: Coon Rapids, IA |
Skilled nursing facility certification: CCN 165358
- Legal name
- THOMAS REST HAVEN
- Doing business as
- THOMAS REST HAVEN
- Certification status
- Active
- Provider type (POS)
- Nursing home – SNF/NF dual certification
- Participating since
- Oct 1, 1997
- Last certification
- Oct 17, 2024
- Beds
- 57
- Ownership / control type
- City/County
- Organization structure
- Other
- Incorporated
- Apr 30, 1968 in IA
- Enrollment address
- 217 Main St
Coon Rapids, IA 50058-1605 - Nursing home name
- THOMAS REST HAVEN
Care Compare: Nursing home
Medicare Care Compare- Listed as
- Thomas Rest Haven
- Overall star rating
- Health inspections
- Staffing
- Quality measures
- Type
- Medicare and Medicaid
- Ownership
- Government - City/county
- Certified
- Oct 1, 1997
- Medicare certification status
- Active
- Certified beds
- 57
- Penalties (3 years)
- 1
Laboratory certificates & supplier records
Derived by NPIMapThese CMS records do not include an NPI. They are shown because their name and street address match this provider’s.
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 16D0382698 | Thomas Rest Haven | Certificate of waiver | Jul 7, 2027 |
National Provider Directory
National Provider DirectoryOwnership & related parties
All disclosed owners & managing parties 3
As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.
| Name | Role | Since | Share |
|---|---|---|---|
| Michael W Hocking | 5% Or Greater Indirect Ownership Interest | Nov 26, 2012 | |
| W-2 Managing Employee | Nov 26, 2012 | ||
| Joan Ruth Irlmeier | Corporate Officer | Mar 14, 2008 | |
| Michael J Davis | Corporate Officer | Nov 8, 2011 |
Practitioners & affiliated clinicians
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": "1132185600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1323820800000",
"number": "1215919949",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "217 MAIN ST",
"city": "COON RAPIDS",
"state": "IA",
"postal_code": "500581605",
"telephone_number": "712-999-2253",
"fax_number": "712-999-5669"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "217 MAIN ST",
"city": "COON RAPIDS",
"state": "IA",
"postal_code": "500581605",
"telephone_number": "712-999-2253",
"fax_number": "712-999-5669"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "THOMAS REST HAVEN",
"organizational_subpart": "NO",
"enumeration_date": "2005-11-17",
"last_updated": "2011-12-14",
"status": "A",
"authorized_official_last_name": "VENTEICHER",
"authorized_official_first_name": "MARY",
"authorized_official_middle_name": "JANE",
"authorized_official_title_or_position": "ADMINISTRATOR",
"authorized_official_telephone_number": "712-999-2253"
},
"taxonomies": [
{
"code": "261QR0400X",
"taxonomy_group": "",
"desc": "Clinic/Center, Rehabilitation",
"state": "IA",
"license": "140430",
"primary": false
},
{
"code": "313M00000X",
"taxonomy_group": "",
"desc": "Nursing Facility/Intermediate Care Facility",
"state": "IA",
"license": "140430",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "WELLMARK",
"identifier": "65358",
"state": "IA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0803973",
"state": "IA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Coon Rapids, IA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 14, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.