NPIMap

Organization Active NPI

Cottage Grove Place

  • Nursing Facility/Intermediate Care Facility
  • Cedar Rapids, IA
National Provider Identifier
1366421281
Registry record updated Aug 28, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nursing Facility/Intermediate Care FacilityTaxonomy code 313M00000X
License
570783 Issued in IA
Legal business name
COTTAGE GROVE PLACE
Practice address
2115 1St Ave SE
Cedar Rapids, IA 52402
Phone
(319) 363-2420
Fax
(319) 297-5646
NPI assigned
Jan 10, 2006
Last updated
Aug 28, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 28, 2019

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

Authorized official

Name
William C. Jacobson
Title
Board Chair
Phone
(319) 363-2420

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nursing Facility/Intermediate Care Facility 313M00000X 570783 IA Primary

Addresses

Primary practice location

2115 1St Ave SE
Cedar Rapids, IA 52402

Mailing address

2115 1St Ave SE
Cedar Rapids, IA 52402-6353
Phone (319) 363-2420

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031105000652 IA Part A Provider - Skilled Nursing Facility 0446162598 Practice locations: Cedar Rapids, IA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1366421281. Details of each certification follow.

Skilled nursing facility certification: CCN 165322

Legal name
COTTAGE GROVE PLACE
Doing business as
COTTAGE GROVE PLACE
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF distinct part
Participating since
May 7, 1997
Last certification
Jul 9, 2024
Beds
64
Ownership / control type
Nonprofit Corporation
Organization structure
CorporationNon-profit
Enrollment address
2115 1St Ave SE
Cedar Rapids, IA 52402-6353
Nursing home name
COTTAGE GROVE PLACE
Affiliated entity
LIFE CARE SERVICES

Care Compare: Nursing home

Medicare Care Compare
Listed as
Cottage Grove PlaceCCN 165322 · All quality measures
Overall star rating
1 of 5
Health inspections
1 of 5
Staffing
4 of 5
Quality measures
4 of 5
Type
Medicare and Medicaid
Ownership
Non profit - Other
Certified
May 7, 1997
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
6454.2 residents per day on average
Chain
Life Care Services43 facilities in the chain

Processed by Care Compare on Aug 1, 2026.

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
16D0924489Cottage Grove Place2115 First Avenue SE, Cedar Rapids, IA 52402Certificate of waiverJan 30, 2027

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 15

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

NameRoleSinceShare
Cottage Grove Place Organization, Cedar Rapids, IA Corporation, Non-profit 5% Or Greater Direct Ownership Interest Oct 1, 1996 100%
Operational/Managerial Control Sep 14, 1992 100%
William McCartan Individual Corporate DirectorBoard Member Sep 1, 2024
Clint Landis Individual Corporate DirectorBoard Member Sep 1, 2022
Vincent a Taeger Individual Operational/Managerial Control Jan 27, 2015
Adp of the SNF Apr 22, 2025
Jana Nassif Individual Corporate DirectorBoard Member Sep 22, 2023
Philip Lenzen Individual Corporate DirectorBoard Member Sep 18, 2019
Leland Smithson Individual Corporate DirectorBoard Member Sep 18, 2019
Edward Sherman Individual Corporate OfficerVice Chair May 20, 2022
Corporate DirectorBoard Member May 20, 2022
Life Care Services LLC Organization, Des Moines, IA LLC, Management services company, For-profit Operational/Managerial Control Jul 1, 2024
Adp of the SNF Apr 23, 2025
First Interstate Bank Organization, West Des Moines, IA Corporation, Financial institution, For-profit 5% Or Greater Security Interest Aug 1, 2012 47%
Richard Landis Individual Corporate OfficerSecretary Jan 1, 2025
Corporate DirectorBoard Member Sep 24, 2021
Jennifer E Snook Individual Operational/Managerial ControlAdministrator Jan 7, 2025
Adp of the SNF Apr 22, 2025
Tad C Cooper Individual Corporate OfficerChair Sep 19, 2019
Corporate DirectorBoard Member Sep 29, 2011
Tory Meiborg Individual Corporate DirectorBoard Member Sep 21, 2018
Michael Hattery Individual Corporate DirectorBoard Member Jun 30, 2021

Owners & managing parties with NPI records 1

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

Facilities with the same owner 57

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

View all 57

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 4

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": "1136851200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1566950400000",
    "number": "1366421281",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2115 1ST AVE SE",
            "city": "CEDAR RAPIDS",
            "state": "IA",
            "postal_code": "524026353",
            "telephone_number": "319-363-2420",
            "fax_number": "319-297-5646"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2115 1ST AVE SE",
            "city": "CEDAR RAPIDS",
            "state": "IA",
            "postal_code": "52402",
            "telephone_number": "319-363-2420",
            "fax_number": "319-297-5646"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COTTAGE GROVE PLACE",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-01-10",
        "last_updated": "2019-08-28",
        "status": "A",
        "authorized_official_last_name": "JACOBSON",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_middle_name": "C.",
        "authorized_official_title_or_position": "BOARD CHAIR",
        "authorized_official_telephone_number": "319-363-2420"
    },
    "taxonomies": [
        {
            "code": "313M00000X",
            "taxonomy_group": "",
            "desc": "Nursing Facility/Intermediate Care Facility",
            "state": "IA",
            "license": "570783",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Cedar Rapids, IA

Sources for this page

Verify at the official NPI Registry.