Souris Valley Care Center, Inc.
Organization Active NPI Skilled Nursing Facility · Velva, ND
NPI 1306821087 · NPPES record last updated Apr 18, 2011
Key facts
- NPI
- 1306821087
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Skilled Nursing Facility 314000000X
- License
- 1091A (ND)
- Legal business name
- SOURIS VALLEY CARE CENTER, INC.
- Practice address
- 300 Main St S
Velva, ND 58790-7342 - Phone
- (701) 338-2072
- Fax
- (701) 338-2031
- NPI assigned
- Dec 14, 2005
- Organization subpart
- Yes
- Parent organization (as reported)
- EVANGELICAL LUTHERAN GOOD SAMARITAN SOCIETY
Authorized official
- Name
- Ms. Raye Nae B Nylander, LNHA
- Title
- Cfo, Executive Vice President
- Phone
- (605) 362-3100
Parent organization (reported in NPPES) 1
Corporate family (same tax ID) 1
Facilities with the same owner 106
Practitioners 3
-
Bruce L Roach, MD
-
Jessica Skjolden, MD
Affiliated clinicians 3
-
Bruce L Roach, MD
-
Jessica Skjolden, MD
Medicare Care Compare: Nursing home
- Listed as
- Souris Valley Care Center
- Overall star rating
- ★☆☆☆☆ 1 of 5
- Health inspections
- ★☆☆☆☆ 1 of 5
- Staffing
- ★★☆☆☆ 2 of 5
- Quality measures
- ★☆☆☆☆ 1 of 5
- Type
- Medicare and Medicaid
- Ownership
- Non profit - Corporation
- Certified
- Sep 1, 1991
- Medicare certification status
- Active
- Certified beds
- 46 · 40.3 residents per day on average
- Chain
- Good Samaritan Society
- Special focus status
- SFF Candidate
- Penalties (3 years)
- 4 · fines totaling $175,053
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in ND
Skilled nursing facility certification: CCN 355109
- Legal name
- SOURIS VALLEY CARE CENTER, INC.
- Doing business as
- SOURIS VALLEY CARE CENTER
- Certification status
- Active
- Provider type (POS)
- Nursing home – SNF/NF dual certification
- Participating since
- Sep 1, 1991
- Last certification
- Apr 24, 2025
- Beds
- 46
- Ownership / control type
- Nonprofit Corporation
- Organization structure
- Corporation · Non-profit
- Incorporated
- Dec 5, 1977 in ND
- Enrollment address
- 300 Main St S
Velva, ND 58790-7342 - Nursing home name
- SOURIS VALLEY CARE CENTER
- Affiliated entity
- GOOD SAMARITAN SOCIETY
All disclosed owners & managing parties 8
| Name | Role | Since | Share |
|---|---|---|---|
| Bonnie Thom |
Corporate Director |
May 28, 2014 | |
| The Evangelical Lutheran Good Samaritan Society |
Operational/Managerial Control | Sep 1, 1991 | |
| Mary Liz Davis |
Corporate Director |
May 28, 2014 | |
| Larry Lee |
Corporate Director |
May 28, 2014 | |
| Alvin Finneseth |
Corporate Director |
May 28, 2014 | |
| Operational/Managerial Control | Feb 1, 2012 | ||
| Valerie Heisler |
Corporate Director |
May 28, 2014 | |
| David Kramer |
Corporate Director |
May 28, 2014 | |
| Dan Flaherty |
Corporate Director |
May 28, 2014 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20050705000945 | ND | Part a Provider - Skilled Nursing Facility | 9830135417 | Practice locations: Velva, ND |
National Provider Directory
- Tax ID family
- Souris Valley Care Center
- Part of
- Red Oak Iowa Good Sam C
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Assisted Living Facility | 310400000X | 025 | ND | |
| Skilled Nursing Facility | 314000000X | 1091A | ND | Yes |
Addresses
Primary practice location
300 Main St S
Velva, ND 58790-7342
Mailing address
300 Main St S
Velva, ND 58790-7342
Phone (701) 338-2072
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000030216 | Medicaid | ND | |
| 8144 | Other | ND | BCBS MD- CI |
Other names
- Souris Valley Care Center
Other providers in Velva, ND
- Marc Miller
- Nicole Wilson Aprn Pmhnp-BC PLLC
- Nicole Petersen
- Shelly Jo Pross
- Souris Valley Care Center
- Bonnie Jean Thom
- Kim A Thorson
- Velva Ambulance Service Inc.
- Velva Drug Company
- Velva Drug Company
All providers in Velva, ND · Skilled Nursing Facility in North Dakota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 18, 2011. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.