Eldercare of Bemidji, Inc

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

333677 Issued in MN

Legal business name

ELDERCARE OF BEMIDJI, INC

Practice address

1633 Delton Ave NW
Bemidji, MN 56601-2537

Phone

(218) 444-1745

Fax

(218) 444-1744

NPI assigned

Sep 25, 2006

Organization subpart

No

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

Authorized official

Name

Barbara Ann Caspers

Title

Business Manager

Phone

(218) 766-1154

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Havenwood Care Center Doing business as

Medicare fee-for-service enrollment

Enrolled in MN

Enrollment records 1

Skilled nursing facility certification: CCN 245397A

Legal name

ELDERCARE OF BEMIDJI INC

Doing business as

HAVENWOOD CARE CENTER

Organization structure

CorporationProprietary

Enrollment address

1633 Delton Ave NW
Bemidji, MN 56601-2537

Nursing home name

HAVENWOOD CARE CENTER

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

CLIA laboratory certificates

Tax ID family

Eldercare of Bemidji Inc3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

• Eldercare of Bemidji, Inc

  • Assisted Living Facility
  • Bemidji, MN
  • NPI 1356969869
  NPD tax ID
• Eldercare of Bemidji, Inc

  • Assisted Living Facility
  • Bemidji, MN
  • NPI 1427145762
  NPD tax ID

All disclosed owners & managing parties 6

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 1

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

• David W Wilcox, MD

  • Family Medicine Physician
  • Bemidji, MN
  • NPI 1124040712

  Adp of the SNF, Operational/Managerial Control

  CMS ownership

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Elizabeth Bernice Berg, M.D.

  • Family Medicine Physician
  • Bemidji, MN
  • NPI 1649614413
  NPD (past)

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

{
    "created_epoch": "1159142400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1686009600000",
    "number": "1295836237",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1633 DELTON AVE NW",
            "city": "BEMIDJI",
            "state": "MN",
            "postal_code": "566012537",
            "telephone_number": "218-444-1745",
            "fax_number": "218-444-1744"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1633 DELTON AVE NW",
            "city": "BEMIDJI",
            "state": "MN",
            "postal_code": "566012537",
            "telephone_number": "218-444-1745",
            "fax_number": "218-444-1744"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ELDERCARE OF BEMIDJI, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-25",
        "last_updated": "2023-06-06",
        "certification_date": "2023-06-06",
        "status": "A",
        "authorized_official_last_name": "CASPERS",
        "authorized_official_first_name": "BARBARA",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "BUSINESS MANAGER",
        "authorized_official_telephone_number": "218-766-1154"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "MN",
            "license": "333677",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "255822000",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Havenwood Care Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Havenwood Care Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Robert A Edwards, O.D.
• Karla Patricia Eischens
• Ejnik and Associates LLC
• Mitchell William Ejnik, PMHNP
• Bonnie Ekstrom, PH D
• Eldercare of Bemidji, Inc
• Eldercare of Bemidji, Inc
• Sherry L Ellefson, CNP
• Stephanie J Else, AU.D.
• Faith Elizabeth Emerson, LADC

• Skilled Nursing Facility in Bemidji, MN
• Providers in Bemidji, MN by specialty
• Skilled Nursing Facility in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 6, 2023; 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.