NPIMap

Organization Active NPI

Riverside Health Care Center

Doing business as Riverside Health & Rehabilitation

  • Skilled Nursing Facility
  • Missoula, MT
National Provider Identifier
1356308399
Registry record updated Sep 24, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
9926 Issued in MT
Legal business name
RIVERSIDE HEALTH CARE CENTER
Doing business as
Riverside Health & Rehabilitation
Practice address
1301 E Broadway St
Missoula, MT 59802-4905
Phone
(406) 721-0680
Fax
(406) 721-9788
NPI assigned
Apr 26, 2006
Last updated
Sep 24, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 24, 2024

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

Authorized official

Name
James A Weichert
Title
Chairman of the Board
Phone
(952) 361-8000

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X
Hearing and Speech Clinic/Center 261QH0700X
Physical Therapy Clinic/Center 261QP2000X
Rehabilitation Clinic/Center 261QR0400X
Skilled Nursing Facility 314000000X 9926 MT Primary

Addresses

Primary practice location

1301 E Broadway St
Missoula, MT 59802-4905

Mailing address

1107 Hazeltine Blvd
Suite 200
Chaska, MN 55318-1009
Phone (952) 361-8000

Other identifiers 7

IdentifierTypeStateIssuer
0212953MedicaidMT
4076-2OtherBCBS OF MONTANA
0311402MedicaidMT
612105MedicaidMT
0344110MedicaidMT
0344123MedicaidMT
0532181MedicaidMT

Other names 1

  • Riverside Health & Rehabilitation Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20060509000990 MT Part A Provider - Skilled Nursing Facility 9335150051 Practice locations: Missoula, MT

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1356308399. Details of each certification follow.

Skilled nursing facility certification: CCN 275126

Legal name
RIVERSIDE HEALTH CARE CENTER
Doing business as
RIVERSIDE HEALTH & REHABILITATION
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Dec 13, 1988
Last certification
Nov 7, 2024
Beds
72
Ownership / control type
Partnership
Organization structure
LLCProprietary
Incorporated
Sep 4, 1987 in MT
Enrollment address
1301 E Broadway St
Missoula, MT 59802-4905
Nursing home name
RIVERSIDE HEALTH & REHABILITATION
Affiliated entity
THE GOODMAN GROUP

Care Compare: Nursing home

Medicare Care Compare
Listed as
Riverside Health & RehabilitationCCN 275126 · All quality measures
Overall star rating
3 of 5
Health inspections
3 of 5
Staffing
4 of 5
Quality measures
4 of 5
Type
Medicare and Medicaid
Ownership
For profit - Partnership
Certified
Dec 13, 1988
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
7266.7 residents per day on average
Chain
The Goodman Group9 facilities in the chain
Penalties (3 years)
1Fines totaling $35,139

Processed by Care Compare on Aug 1, 2026.

National Provider Directory

National Provider Directory
Tax ID family
Riverside Health Care C2 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.

Locations

1107 Hazeltine Blvd
Ste 200
Chaska, MN 55318

Ownership & related parties

All disclosed owners & managing parties 14

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

NameRoleSinceShare
Randall W Benson Individual 5% Or Greater Indirect Ownership InterestGeneral Partner Feb 28, 2017 9.7%
General Partnership InterestGeneral Partner Feb 28, 2017 0.3%
Corporate OfficerTreasurer of Mging General Partner Jun 26, 2015 33.33%
Clinton V Knacke Individual Corporate OfficerChief Financial Officer Oct 12, 2022 100%
Annie M Waylett Individual W-2 Managing EmployeeExecutive Director Dec 4, 2020 100%
Craig E Edinger Individual Corporate OfficerPresident of Mging General Partner Oct 21, 2016 33.33%
OtherPresident of Home Office Adminis Dec 19, 2016
Thomas Jay Salmen Individual 5% Or Greater Indirect Ownership InterestGeneral Partner Feb 28, 2017 9.7%
General Partnership InterestGeneral Partner Feb 28, 2017 0.3%
John B. Goodman 2006 Irrv Grantor TR Organization, Chaska, MN 5% Or Greater Indirect Ownership Interest Feb 28, 2017 24.89%
General Partnership Interest Feb 28, 2017 1.5%
Caron Corporation Organization, Missoula, MT Corporation, For-profit 5% Or Greater Direct Ownership Interest Nov 1, 1988 26.61%
General Partnership Interest Nov 1, 1998 26.61%
The Goodman Group LLC Organization, Chaska, MN LLC, For-profit Other Dec 31, 2006
Providence Health & Services Mt Organization, Missoula, MT Corporation, Non-profit Other Nov 1, 2013
Mark L Wilson Individual 5% Or Greater Indirect Ownership InterestGeneral Partner Feb 28, 2017 9.7%
General Partnership InterestGeneral Partner Feb 28, 2017 0.3%
Jbgrs Inc Organization, Chaska, MN Corporation, For-profit 5% Or Greater Direct Ownership Interest Jan 1, 1996 48.5%
General Partnership Interest Jul 14, 2010 48.5%
Denise a Olson Individual Corporate OfficerSecretary Mging General Partner Sep 16, 2013 33.33%
Riverside Health Care Center Organization, Chaska, MN Created for acquisition, For-profit 5% Or Greater Direct Ownership Interest Sep 4, 1987 100%
James a Weichert Individual 5% Or Greater Indirect Ownership InterestGeneral Partner Feb 28, 2017 9.7%
General Partnership InterestGeneral Partner Feb 28, 2017 0.3%
Corporate DirectorChairman of the Board of Mging GP Mar 30, 2017 100%

Owners & managing parties with NPI records 5

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

Facilities with the same owner 5

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

Practitioners & affiliated clinicians

Practitioners 1

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 2

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": "1146009600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1727136000000",
    "number": "1356308399",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1107 HAZELTINE BLVD",
            "address_2": "SUITE 200",
            "city": "CHASKA",
            "state": "MN",
            "postal_code": "553181009",
            "telephone_number": "952-361-8000",
            "fax_number": "952-361-8058"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1301 E BROADWAY ST",
            "city": "MISSOULA",
            "state": "MT",
            "postal_code": "598024905",
            "telephone_number": "406-721-0680",
            "fax_number": "406-721-9788"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RIVERSIDE HEALTH CARE CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-26",
        "last_updated": "2024-09-24",
        "certification_date": "2024-09-24",
        "status": "A",
        "authorized_official_last_name": "WEICHERT",
        "authorized_official_first_name": "JAMES",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "CHAIRMAN OF THE BOARD",
        "authorized_official_telephone_number": "952-361-8000"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QH0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Hearing and Speech",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QP2000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Physical Therapy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "MT",
            "license": "9926",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0212953",
            "state": "MT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF MONTANA",
            "identifier": "4076-2",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0311402",
            "state": "MT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "612105",
            "state": "MT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0344110",
            "state": "MT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0344123",
            "state": "MT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0532181",
            "state": "MT"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Riverside Health & Rehabilitation",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Missoula, MT

Sources for this page

Verify at the official NPI Registry.