NPIMap

Organization Active NPI

The Emeralds at Grand Rapids LLC

  • Skilled Nursing Facility
  • Grand Rapids, MN
National Provider Identifier
1366916900
Registry record updated Mar 13, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
THE EMERALDS AT GRAND RAPIDS LLC
Practice address
2801 S Highway 169
Grand Rapids, MN 55744-9552
Phone
(218) 326-3431
NPI assigned
Jan 16, 2019
Last updated
Mar 13, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 13, 2019

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

Authorized official

Name
Josh Legum
Title
Ceo
Phone
(507) 203-1001

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X NU Primary

Addresses

Primary practice location

2801 S Highway 169
Grand Rapids, MN 55744-9552

Mailing address

8833 Gross Point Rd Ste 208
Skokie, IL 60077-1859
Phone (507) 203-1001

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20190126000012 MN Part A Provider - Skilled Nursing Facility 1658618889 Practice locations: Grand Rapids, MN

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1366916900. Details of each certification follow.

Skilled nursing facility certification: CCN 245495C

Legal name
THE EMERALDS AT GRAND RAPIDS, LLC
Organization structure
LLCProprietary
Incorporated
Jan 15, 2019 in MN
Enrollment address
2801 S Highway 169
Grand Rapids, MN 55744-9552
Nursing home name
THE EMERALDS AT GRAND RAPIDS LLC
Affiliated entity
MONARCH HEALTHCARE MANAGEMENT

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 11

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

NameRoleSinceShare
Spartan Healthcare LLC Organization, Chicago, IL LLC, For-profit 5% Or Greater Direct Ownership Interest Feb 1, 2019 30%
WBS Holdings LLC Organization, Brooklyn, NY LLC, For-profit 5% Or Greater Direct Ownership Interest Feb 1, 2019 20%
William Stern Individual 5% Or Greater Indirect Ownership Interest Feb 1, 2019 20%
Corporate OfficerChief Financial Officer Feb 1, 2019 20%
Marc Halpert Individual 5% Or Greater Indirect Ownership Interest Feb 1, 2019 30%
Corporate OfficerChief Operations Officer Feb 1, 2019 30%
Jeffrey Arem Individual 5% Or Greater Indirect Ownership Interest Feb 1, 2019 10%
Monarch Healthcare Operating VIII LLC Organization, Mankato, MN LLC, For-profit Operational/Managerial Control Feb 1, 2019 100%
Joshua Legum Individual Contracted Managing EmployeeCeo Feb 1, 2019 30%
5% Or Greater Indirect Ownership Interest Feb 1, 2019 30%
Yazoma Holdings, LLC Organization, Skokie, IL LLC, For-profit 5% Or Greater Direct Ownership Interest Feb 1, 2019 30%
Noam Jaffa Individual 5% Or Greater Indirect Ownership Interest Feb 1, 2019 10%
Corporate DirectorDirector of Procurement Feb 1, 2019 10%
Nij LLC Organization, St Louis Park, MN LLC, For-profit 5% Or Greater Direct Ownership Interest Feb 1, 2019 10%
Jca Holdings LLC Organization, Brooklyn, NY LLC, For-profit 5% Or Greater Direct Ownership Interest Feb 1, 2019 10%

Facilities with the same owner 44

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

View all 44

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.

NPI Registry JSON

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

{
    "created_epoch": "1547596800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1552435200000",
    "number": "1366916900",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8833 GROSS POINT RD STE 208",
            "city": "SKOKIE",
            "state": "IL",
            "postal_code": "600771859",
            "telephone_number": "507-203-1001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2801 S HIGHWAY 169",
            "city": "GRAND RAPIDS",
            "state": "MN",
            "postal_code": "557449552",
            "telephone_number": "218-326-3431"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE EMERALDS AT GRAND RAPIDS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-01-16",
        "last_updated": "2019-03-13",
        "status": "A",
        "authorized_official_last_name": "LEGUM",
        "authorized_official_first_name": "JOSH",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "507-203-1001"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Grand Rapids, MN

Sources for this page

Verify at the official NPI Registry.