Active NPI
Glen Haven Home, Inc.
Doing business as Glen Haven Village
- Skilled Nursing Facility
- Glenwood, IA
National Provider Identifier
1407931546
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Skilled Nursing Facility
- License
- 650355
- Legal business name
- GLEN HAVEN HOME, INC.
- Doing business as
- Glen Haven Village
- Practice address
- 133 Indian Hills Dr
Glenwood, IA 51534-1911 - Phone
- (712) 302-9016
- Fax
- (712) 302-9017
- NPI assigned
- Oct 26, 2006
- Last updated
- Feb 26, 2026
- 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
- Julianne M Marriott, NHA
- Title
- Administrator
- Phone
- (712) 302-9016
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Skilled Nursing Facility | 314000000X | 650355 | IA | Primary |
Addresses
Primary practice location
133 Indian Hills Dr
Glenwood, IA 51534-1911
Mailing address
133 Indian Hills Dr
Glenwood, IA 51534-1911
Phone (712) 302-9016
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0801365 | Medicaid | IA | |
| 65530 | Other | IA | BC BS |
Other names 1
- Glen Haven Village
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IA
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20030612000023 | IA | Part A Provider - Skilled Nursing Facility | 0446160659 | Practice locations: Glenwood, IA |
NPI to CCN mapping 1
The Medicare certification numbers (CCNs) connected to NPI 1407931546. Details of each certification follow.
Skilled nursing facility certification: CCN 165530
- Legal name
- GLEN HAVEN HOME INC
- Doing business as
- GLEN HAVEN VILLAGE
- Certification status
- Active
- Provider type (POS)
- Nursing home – SNF/NF dual certification
- Participating since
- May 6, 2004
- Last certification
- Jul 11, 2024
- Beds
- 69
- Ownership / control type
- Nonprofit Corporation
- Organization structure
- Corporation
- Incorporated
- Aug 25, 1977 in IA
- Enrollment address
- 252 Indian Hills Dr
Glenwood, IA 51534-1912 - Nursing home name
- GLEN HAVEN VILLAGE
Care Compare: Nursing home
Medicare Care Compare- Listed as
- Glen Haven Village
- Overall star rating
- Health inspections
- Staffing
- Quality measures
- Type
- Medicare and Medicaid
- Ownership
- Non profit - Corporation
- Certified
- May 6, 2004
- Medicare certification status
- Active
- Certified beds
- 69
- Penalties (3 years)
- 4
National Provider Directory
National Provider Directory- Tax ID family
- Glen Haven Home Inc
Other organizations with this tax ID 1
Organizations that report the same tax identification number in the National Provider Directory.
Ownership & related parties
All disclosed owners & managing parties 10
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 |
|---|---|---|---|
| Glen Haven Home Inc | 5% Or Greater Direct Ownership Interest | May 1, 1978 | 100% |
| Richard Lincoln | Corporate Officer | Sep 1, 2016 | 100% |
| HHS Solutions LLC | Operational/Managerial Control | Dec 21, 2007 | 100% |
| Larry Raabe | Corporate Officer | Sep 1, 2008 | 100% |
| Matthew R Ross | Contracted Managing Employee | Dec 21, 2007 | 100% |
| Corporate Officer | Dec 21, 2007 | 100% | |
| Corporate Director | Dec 21, 2007 | 100% | |
| David John Jaskierny | Corporate Officer | Sep 1, 2012 | 100% |
| Ron D Ross | Contracted Managing Employee | Dec 21, 2007 | 100% |
| Corporate Officer | Dec 21, 2007 | 100% | |
| Corporate Director | Dec 21, 2007 | 100% | |
| Barbara Mass | Corporate Officer | Feb 15, 2017 | 100% |
| Julianne Marriott | Contracted Managing Employee | Nov 1, 2016 | 100% |
| Corporate Director | Nov 1, 2016 | 100% | |
| Don Schoening | Corporate Officer | Feb 15, 2017 | 100% |
Owners & managing parties with NPI records 1
Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.
-
- Anatomic Pathology & Clinical Pathology Physician
- Omaha, NE
- NPI 1205913126
Corporate Officer
Practitioners & affiliated clinicians
Affiliated clinicians 7
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": "1161820800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1772064000000",
"number": "1407931546",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "133 INDIAN HILLS DR",
"city": "GLENWOOD",
"state": "IA",
"postal_code": "515341911",
"telephone_number": "712-302-9016",
"fax_number": "712-302-9017"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "133 INDIAN HILLS DR",
"city": "GLENWOOD",
"state": "IA",
"postal_code": "515341911",
"telephone_number": "712-302-9016",
"fax_number": "712-302-9017"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "GLEN HAVEN HOME, INC.",
"organizational_subpart": "NO",
"enumeration_date": "2006-10-26",
"last_updated": "2026-02-26",
"certification_date": "2026-02-26",
"status": "A",
"authorized_official_last_name": "MARRIOTT",
"authorized_official_first_name": "JULIANNE",
"authorized_official_middle_name": "M",
"authorized_official_title_or_position": "ADMINISTRATOR",
"authorized_official_telephone_number": "712-302-9016",
"authorized_official_credential": "NHA"
},
"taxonomies": [
{
"code": "314000000X",
"taxonomy_group": "",
"desc": "Skilled Nursing Facility",
"state": "IA",
"license": "650355",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0801365",
"state": "IA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BC BS",
"identifier": "65530",
"state": "IA"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Glen Haven Village",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Glenwood, IA
- Rebecca Lee Fipps, RBT
- Five Star Quality Care-Ia, Inc. (Park Place)
- Chelsea Leanne Frazier
- Robert Kenneth Fryzek, M.D.
- Gle Glenwood LLC (Young Vision Care)
- Glen Haven Home, Inc. (Glen Haven Village)
- Glenwood C.S.D.
- Glenwood Family Dentistry PC
- Glenwood Resource Center (Glenwood Resource Center Pharmacy)
- Glenwood Resource Center
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 26, 2026; 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.