Village of Fertile

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

327713 Issued in MN

Legal business name

VILLAGE OF FERTILE

Practice address

300 Garfield Ave. SE
Fertile, MN 56540-0008

Phone

(218) 945-6194

Fax

(218) 945-6459

NPI assigned

May 23, 2005

Last updated

Dec 13, 2023By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Lisa Joy Liden

Title

City Administrator

Phone

(218) 945-6194

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Fair Meadow Nursing Home Other name

Medicare fee-for-service enrollment

Enrolled in MN

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1417950593. Details of each certification follow.

• CCN 245545 Skilled nursing facility · Active · Details

Skilled nursing facility certification: CCN 245545

Legal name

VILLAGE OF FERTILE

Doing business as

FAIR MEADOW NURSING HOME

Certification status

Active

Provider type (POS)

Nursing home – SNF/NF dual certification

Participating since

Feb 1, 1991

Last certification

Aug 27, 2024

Beds

42

Ownership / control type

Other Nonprofit

Organization structure

GovernmentNon-profit

Incorporated

Feb 1, 1991 in MN

Enrollment address

300 Garfield Seave
Fertile, MN 56540-4136

Nursing home name

FAIR MEADOW NURSING HOME

Listed as

Fair Meadow Nursing HomeCCN 245545 · All quality measures

Overall star rating

4 of 5

Health inspections

4 of 5

Staffing

3 of 5

Quality measures

2 of 5

Type

Medicare and Medicaid

Ownership

Non profit - Other

Certified

Feb 1, 1991

Medicare certification status

ActiveFrom the Provider of Services file

Certified beds

4239.2 residents per day on average

Processed by Care Compare on Aug 1, 2026.

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

CLIA laboratory certificates

All disclosed owners & managing parties 9

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

Owners & managing parties with NPI records 2

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

• Matthew Steven Massmann, PA-C

  • Physician Assistant
  • Crookston, MN
  • NPI 1215292750

  Corporate Director

  CMS ownership
• Cheryl White, MD

  • Family Medicine Physician
  • Fosston, MN
  • NPI 1457791725

  Adp of the SNF, Contracted Managing Employee

  CMS ownership

Practitioners 3

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.

• Ian Glidden, MD

  • Family Medicine Physician
  • Crookston, MN
  • NPI 1639752926
  NPD (past)
• Erik J Kanten, MD

  • Family Medicine Physician
  • Crookston, MN
  • NPI 1679593206
  NPD (past)
• Cheryl White, MD

  • Family Medicine Physician
  • Fosston, MN
  • NPI 1457791725
  NPD (past)

Affiliated clinicians 3

Clinicians who list this facility as an affiliation in Medicare Care Compare.

• Ian Glidden, MD

  • Family Medicine Physician
  • Crookston, MN
  • NPI 1639752926

  Nursing home

  Care Compare affiliation
• Darren D Swanson, MD

  • Family Medicine Physician
  • Fosston, MN
  • NPI 1912942566

  Nursing home

  Care Compare affiliation
• Cheryl White, MD

  • Family Medicine Physician
  • Fosston, MN
  • NPI 1457791725

  Nursing home

  Care Compare affiliation

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

{
    "created_epoch": "1116806400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1702425600000",
    "number": "1417950593",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 8",
            "address_2": "300 GARFIELD AVE. SE",
            "city": "FERTILE",
            "state": "MN",
            "postal_code": "565400008",
            "telephone_number": "218-945-6194",
            "fax_number": "218-945-6459"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 GARFIELD AVE. SE",
            "city": "FERTILE",
            "state": "MN",
            "postal_code": "565400008",
            "telephone_number": "218-945-6194",
            "fax_number": "218-945-6459"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VILLAGE OF FERTILE",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-05-23",
        "last_updated": "2023-12-13",
        "certification_date": "2023-12-13",
        "status": "A",
        "authorized_official_last_name": "LIDEN",
        "authorized_official_first_name": "LISA",
        "authorized_official_middle_name": "JOY",
        "authorized_official_title_or_position": "CITY ADMINISTRATOR",
        "authorized_official_telephone_number": "218-945-6194"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "MN",
            "license": "327713",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS/BLUE SHIELD",
            "identifier": "4541FA",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "804740500",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Fair Meadow Nursing Home",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Fair Meadow Nursing Home",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Steven Llewellyn Poissant, PT.,L., AC.,C.S.C.S
• Tammie Radermacher, LPN/HOUSING MANAGER
• Riverview Healthcare Association (RiverView Rehab Services Fertile)
• Riverview Healthcare Association
• Thrifty Drug Stores Inc (Thrifty White Drug #750)

• Skilled Nursing Facility in Fertile, MN
• Providers in Fertile, MN by specialty
• Skilled Nursing Facility in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 13, 2023; 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.

Verify at the official NPI Registry.