NPIMap

Organization Active NPI

Spearfish Nursing and Rehab Center LLC

  • Skilled Nursing Facility
  • Spearfish, SD
National Provider Identifier
1417420555
Registry record updated Oct 23, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
SPEARFISH NURSING AND REHAB CENTER LLC
Practice address
1020 N 10TH St
Spearfish, SD 57783-2203
Phone
(801) 601-1450
NPI assigned
Jan 10, 2019
Last updated
Oct 23, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 23, 2024

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

Authorized official

Name
Dustin Monroe
Title
General Counsel
Phone
(385) 240-6408

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X Primary

Addresses

Primary practice location

1020 N 10TH St
Spearfish, SD 57783-2203

Mailing address

1376 E 3300 S
Salt Lake City, UT 84106-3069

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20190219001633 SD Part A Provider - Skilled Nursing Facility 6305184268 Practice locations: Spearfish, SD

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1417420555. Details of each certification follow.

Skilled nursing facility certification: CCN 435043

Legal name
SPEARFISH NURSING AND REHAB CENTER LLC
Doing business as
SPEARFISH CANYON HEALTHCARE
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Feb 10, 1990
Last certification
Feb 7, 2024
Beds
105
Ownership / control type
Limited Liability Corporation
Multi-facility organization
Eduro Healthcare
Organization structure
LLCProprietary
Incorporated
Dec 7, 2018 in SD
Enrollment address
1020 N 10TH St
Spearfish, SD 57783-2203
Nursing home name
SPEARFISH CANYON HEALTHCARE
Affiliated entity
EDURO HEALTHCARE

Care Compare: Nursing home

Medicare Care Compare
Listed as
Spearfish Canyon HealthcareCCN 435043 · All quality measures
Overall star rating
2 of 5
Health inspections
2 of 5
Staffing
3 of 5
Quality measures
4 of 5
Type
Medicare and Medicaid
Ownership
For profit - Limited Liability company
Certified
Feb 10, 1990
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
10575.9 residents per day on average
Chain
Eduro Healthcare34 facilities in the chain
Abuse citation
Cited for abuse (Care Compare abuse icon)
Penalties (3 years)
1Fines totaling $9,718

Processed by Care Compare on Aug 1, 2026.

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 4

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

NameRoleSinceShare
Michael C Bewsey Individual 5% Or Greater Indirect Ownership Interest Feb 1, 2019 50%
Operational/Managerial ControlManaging Partner Feb 1, 2019 50%
Brian J Ramos Individual 5% Or Greater Indirect Ownership Interest Feb 1, 2019 50%
Christopher M Thompson Individual Corporate OfficerPresident Feb 1, 2019
W-2 Managing EmployeePresident Feb 1, 2019
Eduro Healthcare LLC Organization, Salt Lake City, UT LLC 5% Or Greater Direct Ownership Interest Feb 1, 2019 100%
Operational/Managerial Control Feb 1, 2019 100%

Facilities with the same owner 13

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

View all 13

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 1

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": "1547078400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1729641600000",
    "number": "1417420555",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1376 E 3300 S",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841063069"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1020 N 10TH ST",
            "city": "SPEARFISH",
            "state": "SD",
            "postal_code": "577832203",
            "telephone_number": "801-601-1450"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPEARFISH NURSING AND REHAB CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-01-10",
        "last_updated": "2024-10-23",
        "certification_date": "2024-10-23",
        "status": "A",
        "authorized_official_last_name": "MONROE",
        "authorized_official_first_name": "DUSTIN",
        "authorized_official_title_or_position": "GENERAL COUNSEL",
        "authorized_official_telephone_number": "385-240-6408"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Spearfish, SD

Sources for this page

Verify at the official NPI Registry.