4000 Valley Square Inc

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

1077A Issued in ND

Legal business name

4000 VALLEY SQUARE INC

Doing business as

Country Estates
Valley Senior Living on 42nd
Woodside Village1 more in Other names

Practice address

4000 24TH Ave S
Grand Forks, ND 58201-8863

Phone

(701) 787-7500

Fax

(701) 787-7822

NPI assigned

Oct 3, 2006

Last updated

Aug 22, 2019By the provider in NPPES

Organization subpart

Yes

Parent organization

VALLEY MEMORIAL HOMESAs reported in NPPES

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

Authorized official

Name

Mrs. Megan Anderson

Title

Administrative Project Coordinator

Phone

(701) 787-7970

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 4

• Country Estates Doing business as
• Valley Senior Living on 42nd Doing business as
• WOODSIDE VILLAGE Doing business as
• Wheatland Terrace Doing business as

Medicare fee-for-service enrollment

Enrolled in ND

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1275627184. Details of each certification follow.

• CCN 355112 Skilled nursing facility · Active · Details

Skilled nursing facility certification: CCN 355112

Legal name

4000 VALLEY SQUARE INC

Doing business as

WOODSIDE VILLAGE

Certification status

Active

Provider type (POS)

Nursing home – SNF/NF dual certification

Participating since

Dec 1, 1991

Last certification

Jan 8, 2025

Beds

138

Ownership / control type

Church Related

Multi-facility organization

Valley Senior Living

Organization structure

CorporationNon-profit

Incorporated

Nov 12, 1977 in ND

Enrollment address

4004 24TH Ave S
Grand Forks, ND 58201-8863

Nursing home name

WOODSIDE VILLAGE

Listed as

Woodside VillageCCN 355112 · 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 - Church related

Certified

Dec 1, 1991

Medicare certification status

ActiveFrom the Provider of Services file

Certified beds

138129.0 residents per day on average

Penalties (3 years)

1Fines totaling $8,278

Processed by Care Compare on Aug 1, 2026.

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

All disclosed owners & managing parties 24

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

Owners & managing parties with NPI records 16

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

• Altru Health System

  dba Altru Health System (Prosthetics and Orthotics)

  • Prosthetic/Orthotic Supplier
  • Grand Forks, ND
  • NPI 1033257704

  Adp of the SNF, Operational/Managerial Control

  CMS ownership
• Altru Health System

  dba Altru 1300 Columbia

  • Clinic/Center
  • Grand Forks, ND
  • NPI 1043309552

  Adp of the SNF, Operational/Managerial Control

  CMS ownership
• Altru Health System

  dba Altru Care Flight

  • Ambulance
  • Grand Forks, ND
  • NPI 1114485315

  Adp of the SNF, Operational/Managerial Control

  CMS ownership
• Altru Health System

  dba Altru Renal Dialysis Devils Lake

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Devils Lake, ND
  • NPI 1124117692

  Adp of the SNF, Operational/Managerial Control

  CMS ownership
• Altru Health System

  dba Family Medicine Residency Pharmacy

  • Clinic Pharmacy
  • Grand Forks, ND
  • NPI 1144368085

  Adp of the SNF, Operational/Managerial Control

  CMS ownership
• Altru Health System

  • General Acute Care Hospital
  • Grand Forks, ND
  • NPI 1154346161

  Adp of the SNF, Operational/Managerial Control

  CMS ownership
• Altru Health System

  dba Altru Home Health

  • Home Health Agency
  • Grand Forks, ND
  • NPI 1346339850

  Adp of the SNF, Operational/Managerial Control

  CMS ownership
• Altru Health System

  • Home Infusion Therapy Pharmacy
  • Grand Forks, ND
  • NPI 1497844906

  Adp of the SNF, Operational/Managerial Control

  CMS ownership
• Altru Health System

  • Clinic/Center
  • Grand Forks, ND
  • NPI 1811617103

  Adp of the SNF, Operational/Managerial Control

  CMS ownership
• Altru Health System

  dba Altru Clinic - Devils Lake

  • Rural Health Clinic/Center
  • Devils Lake, ND
  • NPI 1912632449

  Adp of the SNF, Operational/Managerial Control

  CMS ownership
• Chris Henderson, MD

  • Family Medicine Physician
  • Grand Forks, ND
  • NPI 1669766283

  Adp of the SNF, Operational/Managerial Control

  CMS ownership
• Altru Health System

  dba Altru Health System-Renal Dialysis at Lifecare

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Roseau, MN
  • NPI 1144518549

  Adp of the SNF, Operational/Managerial Control

  CMS ownership

Facilities with the same owner 3

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

• Altru Health System

  dba Altru Home Health

  • Home Health Agency
  • Grand Forks, ND
  • NPI 1346339850

  Altru Health System

  CMS ownership
• Rehabilitation Hospital of Grand Forks, LLC

  dba Altru Rehabilitation Hospital

  • Rehabilitation Hospital
  • Grand Forks, ND
  • NPI 1922751452

  Altru Health System

  CMS ownership
• Valley Homes and Services

  dba Valley Eldercare Center

  • Skilled Nursing Facility
  • Grand Forks, ND
  • NPI 1881762565

  Altru Health System, Valley Senior Living

  CMS ownership

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.

• Gina Ruth Roller, PT

  • Physical Therapist
  • Grand Forks, ND
  • NPI 1932328234
  NPD
• Chris Henderson, MD

  • Family Medicine Physician
  • Grand Forks, ND
  • NPI 1669766283
  NPD (past)
• Taylor Volberding

  • Family Medicine Physician
  • Grand Forks, ND
  • NPI 1427625193
  NPD (past)

Affiliated clinicians 2

Clinicians who list this facility as an affiliation in Medicare Care Compare.

• Chris Henderson, MD

  • Family Medicine Physician
  • Grand Forks, ND
  • NPI 1669766283

  Nursing home

  Care Compare affiliation
• Taylor Volberding

  • Family Medicine Physician
  • Grand Forks, ND
  • NPI 1427625193

  Nursing home

  Care Compare affiliation

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1159833600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1566432000000",
    "number": "1275627184",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4000 24TH AVE S",
            "city": "GRAND FORKS",
            "state": "ND",
            "postal_code": "582018863",
            "telephone_number": "701-787-7500",
            "fax_number": "701-787-7822"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4000 24TH AVE S",
            "city": "GRAND FORKS",
            "state": "ND",
            "postal_code": "582018863",
            "telephone_number": "701-787-7500",
            "fax_number": "701-787-7822"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "4000 VALLEY SQUARE INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "VALLEY MEMORIAL HOMES",
        "enumeration_date": "2006-10-03",
        "last_updated": "2019-08-22",
        "status": "A",
        "authorized_official_last_name": "ANDERSON",
        "authorized_official_first_name": "MEGAN",
        "authorized_official_title_or_position": "ADMINISTRATIVE PROJECT COORDINATOR",
        "authorized_official_telephone_number": "701-787-7970",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "ND",
            "license": "1077A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "03-0201",
            "state": "ND"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Country Estates",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Country Estates",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Valley Senior Living on 42nd",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "WOODSIDE VILLAGE",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Wheatland Terrace",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• 1101 Dental, PLLC
• A Johnston Therapy, PLLC
• A. Schlager Chiropractic Clinic
• Bradley C Aafedt, MD
• Shosti L. Aaker
• Rebekah J Aakre, NP

• Skilled Nursing Facility in Grand Forks, ND
• Providers in Grand Forks, ND by specialty
• Skilled Nursing Facility in North Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2019; 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.

Verify at the official NPI Registry.