Active NPI
Forest Health Services Inc.
Doing business as Cornerstone Villa
- Skilled Nursing Facility
- Buhl, MN
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Skilled Nursing Facility
- License
- 333238
- Legal business name
- FOREST HEALTH SERVICES INC.
- Doing business as
- Cornerstone Villa
- Practice address
- 1000 Forest St
Buhl, MN 55713-0724 - Phone
- (218) 258-8742
- Fax
- (218) 258-8767
- NPI assigned
- Jan 19, 2007
- Last updated
- Sep 25, 2013
- 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
- Ms. Debra S Doughty
- Title
- Administrator President
- Phone
- (218) 258-8742
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Skilled Nursing Facility | 314000000X | 333238 | MN | Primary |
Addresses
Primary practice location
1000 Forest St
Buhl, MN 55713-0724
Mailing address
1000 Forest St
PO Box 724
Buhl, MN 55713-0724
Phone (218) 258-8742
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 71 00447 | Other | MN | MEDICA PROVIDER NUMBER |
| 5R32CO | Other | MN | BCBS PROVIDER NUMBER |
| 884696100 | Medicaid | MN | |
| NH0510 | Other | MN | UCARE PROVIDER NUMBER |
Other names 1
- Cornerstone Villa
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MN
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040322001030 | MN | Part A Provider - Skilled Nursing Facility | 2062303910 | Practice locations: Buhl, MN |
NPI to CCN mapping 1
The Medicare certification numbers (CCNs) connected to NPI 1346393642. Details of each certification follow.
Skilled nursing facility certification: CCN 245612
- Legal name
- FOREST HEALTH SERVICES INC
- Doing business as
- CORNERSTONE VILLA
- Certification status
- Active
- Provider type (POS)
- Nursing home – SNF/NF dual certification
- Participating since
- Jul 16, 2004
- Last certification
- Oct 31, 2024
- Beds
- 43
- Ownership / control type
- Nonprofit Corporation
- Organization structure
- Corporation
- Enrollment address
- 1000 Forest St
Buhl, MN 55713-4495 - Nursing home name
- CORNERSTONE VILLA
Care Compare: Nursing home
Medicare Care Compare- Listed as
- Cornerstone Villa
- Overall star rating
- Health inspections
- Staffing
- Quality measures
- Type
- Medicare and Medicaid
- Ownership
- Non profit - Corporation
- Certified
- Jul 16, 2004
- Medicare certification status
- Active
- Certified beds
- 43
- Penalties (3 years)
- 2
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 |
|---|---|---|---|
| 24D1026910 | Forest Health Services | Certificate of waiver | Jun 16, 2028 |
National Provider Directory
National Provider DirectoryOwnership & related parties
All disclosed owners & managing parties 7
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 |
|---|---|---|---|
| Jeff Dobson | Operational/Managerial Control | Jul 1, 2004 | |
| Adp of the SNF | Jul 1, 2004 | ||
| Ketti Chamberlin | Corporate Officer | Feb 14, 2022 | |
| Corporate Director | Jul 1, 2022 | ||
| Operational/Managerial Control | Jul 1, 2022 | ||
| Adp of the SNF | Jul 1, 2022 | ||
| Cassidie R Kunkel | Corporate Officer | Jul 25, 2022 | |
| Corporate Director | Jul 25, 2022 | ||
| Operational/Managerial Control | Jul 25, 2022 | ||
| Adp of the SNF | Jul 25, 2022 | ||
| Dean M Fox | Operational/Managerial Control | Jul 1, 2022 | |
| Adp of the SNF | Jul 1, 2022 | ||
| Rina Edstrom | Corporate Director | Jul 1, 2023 | |
| Operational/Managerial Control | Jul 1, 2023 | ||
| Managing Control - Governing Body | Jul 1, 2023 | ||
| Adp of the SNF | Jul 1, 2023 | ||
| Donald Carlson | Corporate Director | Jan 1, 2010 | |
| Operational/Managerial Control | Jan 1, 2010 | ||
| Adp of the SNF | Jan 1, 2010 | ||
| Lea Sauter | Operational/Managerial Control | Oct 1, 2022 | |
| Adp of the SNF | Oct 1, 2022 |
Owners & managing parties with NPI records 1
Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.
-
- Hospice and Palliative Medicine (Internal Medicine) Physician
- Duluth, MN
- NPI 1477585032
Adp of the SNF, Operational/Managerial Control
Practitioners & affiliated clinicians
Practitioners 2
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.
-
- Geriatric Medicine (Family Medicine) Physician
- Hibbing, MN
- NPI 1952669525
-
- Geriatric Medicine (Family Medicine) Physician
- Golden Valley, MN
- NPI 1023021409
Affiliated clinicians 3
Clinicians who list this facility as an affiliation in Medicare Care Compare.
-
- Geriatric Medicine (Family Medicine) Physician
- Hibbing, MN
- NPI 1952669525
Nursing home
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1169164800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1380067200000",
"number": "1346393642",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1000 FOREST ST",
"address_2": "PO BOX 724",
"city": "BUHL",
"state": "MN",
"postal_code": "557130724",
"telephone_number": "218-258-8742",
"fax_number": "218-258-8767"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1000 FOREST ST",
"city": "BUHL",
"state": "MN",
"postal_code": "557130724",
"telephone_number": "218-258-8742",
"fax_number": "218-258-8767"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "FOREST HEALTH SERVICES INC.",
"organizational_subpart": "NO",
"enumeration_date": "2007-01-19",
"last_updated": "2013-09-25",
"status": "A",
"authorized_official_last_name": "DOUGHTY",
"authorized_official_first_name": "DEBRA",
"authorized_official_middle_name": "S",
"authorized_official_title_or_position": "ADMINISTRATOR PRESIDENT",
"authorized_official_telephone_number": "218-258-8742",
"authorized_official_name_prefix": "Ms."
},
"taxonomies": [
{
"code": "314000000X",
"taxonomy_group": "",
"desc": "Skilled Nursing Facility",
"state": "MN",
"license": "333238",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICA PROVIDER NUMBER",
"identifier": "71 00447",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS PROVIDER NUMBER",
"identifier": "5R32CO",
"state": "MN"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "884696100",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UCARE PROVIDER NUMBER",
"identifier": "NH0510",
"state": "MN"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Cornerstone Villa",
"code": "3",
"type": "Doing Business As"
}
]
}
Other providers in Buhl, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 25, 2013; 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.