NPIMap

Organization Active NPI

Ebenezer Ridges

  • Skilled Nursing Facility
  • Burnsville, MN
National Provider Identifier
1265433767
Registry record updated Feb 25, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
328249 Issued in MN
Legal business name
EBENEZER RIDGES
Practice address
13820 Community Dr
Burnsville, MN 55337-4519
Phone
(952) 898-8400
Fax
(952) 898-8450
NPI assigned
Aug 9, 2005
Last updated
Feb 25, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 25, 2013

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

Authorized official

Name
Ms. Erin Hilligan
Title
Administrator
Phone
(952) 898-8410

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X 328249 MN Primary

Addresses

Primary practice location

13820 Community Dr
Burnsville, MN 55337-4519

Mailing address

13820 Community Dr
Burnsville, MN 55337-4519
Phone (952) 898-8400

Other identifiers 2

IdentifierTypeStateIssuer
834243100MedicaidMN
328249OtherMNSTATE LICENSE

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050303001030 MN Part A Provider - Skilled Nursing Facility 1254385032 Practice locations: Burnsville, MN

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1265433767. Details of each certification follow.

Skilled nursing facility certification: CCN 245213

Legal name
EBENEZER RIDGES
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Dec 1, 1976
Last certification
Nov 21, 2024
Beds
114
Ownership / control type
Nonprofit Corporation
Multi-facility organization
Ebenezer
Organization structure
CorporationNon-profit
Enrollment address
13820 Community Dr
Burnsville, MN 55337-4519
Nursing home name
EBENEZER RIDGES GERIATRIC CARE CENTER
Affiliated entity
EBENEZER SENIOR LIVING

Care Compare: Nursing home

Medicare Care Compare
Listed as
Ebenezer Ridges Geriatric Care CenterCCN 245213 · All quality measures
Overall star rating
4 of 5
Health inspections
4 of 5
Staffing
4 of 5
Quality measures
2 of 5
Type
Medicare and Medicaid
Ownership
Non profit - Corporation
Certified
Dec 1, 1976
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
114104.1 residents per day on average
Chain
Ebenezer Senior Living6 facilities in the chain

Processed by Care Compare on Aug 1, 2026.

National Provider Directory

National Provider Directory
Tax ID family
Ebenezer Ridges2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

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
Jackson Bires Individual Operational/Managerial Control Jul 8, 2024
Adp of the SNF Apr 16, 2025
Susan Carlson-Weinberg Individual Corporate DirectorBoard Member May 31, 2019
Managing Control - Governing Body May 31, 2019
Yasser Chebli Individual Operational/Managerial Control Jan 1, 2020
Adp of the SNF Apr 16, 2025
Carolyn Jacobson Individual Corporate DirectorBoard Member Oct 1, 2018
Managing Control - Governing Body Oct 1, 2018
Brett Anderson Individual Corporate OfficerPresident & Ceo Sep 5, 2024
James Hereford Individual Corporate DirectorBoard Member Aug 1, 2017
Managing Control - Governing Body Aug 1, 2017
Todd Willett Individual Corporate OfficerChief Financial Officer Oct 24, 2016
Ebenezer Management Services Inc Organization, Edina, MN Corporation, For-profit, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Jan 1, 1976
Operational/Managerial Control Jan 1, 1976
Adp of the SNF Jan 29, 2025
Scott Wordelman Individual Corporate DirectorBoard Member Aug 24, 2017
Managing Control - Governing Body Aug 24, 2017
Margaret Milius Individual Corporate DirectorBoard Member Feb 21, 2024
Managing Control - Governing Body Feb 21, 2024
Robert Walker Individual Corporate DirectorBoard Member May 27, 2022
Managing Control - Governing Body May 27, 2022
Mark Landreville Individual Corporate DirectorBoard Member Feb 21, 2024
Managing Control - Governing Body Feb 21, 2024
Kenneth Piper Individual Corporate DirectorBoard Member May 27, 2022
Managing Control - Governing Body May 27, 2022
Kim Faust Individual Corporate DirectorBoard Member Sep 21, 2021
Managing Control - Governing Body Sep 21, 2021
Ebenezer Society Organization, Edina, MN Corporation, Non-profit, Chain home office 5% Or Greater Indirect Ownership Interest Dec 1, 1976 100%
Gayle Kvenvold Individual Corporate DirectorBoard Member May 23, 2024
Managing Control - Governing Body May 23, 2024
Brittany Bell Individual Operational/Managerial Control Sep 6, 2021

Owners & managing parties with NPI records 3

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 5

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 4

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": "1123545600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1361750400000",
    "number": "1265433767",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13820 COMMUNITY DR",
            "city": "BURNSVILLE",
            "state": "MN",
            "postal_code": "553374519",
            "telephone_number": "952-898-8400",
            "fax_number": "952-898-8450"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13820 COMMUNITY DR",
            "city": "BURNSVILLE",
            "state": "MN",
            "postal_code": "553374519",
            "telephone_number": "952-898-8400",
            "fax_number": "952-898-8450"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EBENEZER RIDGES",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-08-09",
        "last_updated": "2013-02-25",
        "status": "A",
        "authorized_official_last_name": "HILLIGAN",
        "authorized_official_first_name": "ERIN",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "952-898-8410",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "MN",
            "license": "328249",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "834243100",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "328249",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Burnsville, MN

Sources for this page

Verify at the official NPI Registry.