Karlstad Healthcare Center, Inc
Organization Active NPI Skilled Nursing Facility · Karlstad, MN
NPI 1477541951 · NPPES record last updated Oct 20, 2008
Key facts
- NPI
- 1477541951
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Skilled Nursing Facility 314000000X
- License
- 330265 (MN)
- Legal business name
- KARLSTAD HEALTHCARE CENTER, INC
- Practice address
- 304 Washington Ave W
Karlstad, MN 56732-4018 - Phone
- (218) 436-2161
- NPI assigned
- Oct 10, 2005
- Organization subpart
- No
Authorized official
- Name
- Howie Groff
- Title
- President
- Phone
- (952) 888-2923
Owners & managing parties with NPI records 1
-
James E Surdy, M.D.
Corporate family (same tax ID) 1
Facilities with the same owner 8
Practitioners 1
-
James E Surdy, M.D.
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 24D0893772 | Karlstad Healthcare Center Inc | Certificate of waiver | Oct 27, 2026 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MN
Skilled nursing facility certification: CCN 245468B
- Legal name
- KARLSTAD HEALTHCARE CENTER, INC
- Organization structure
- Corporation · Proprietary
- Incorporated
- Aug 30, 1995 in MN
- Enrollment address
- 304 Washington Ave W
Karlstad, MN 56732-4018 - Nursing home name
- KARLSTAD HEALTHCARE CENTER INC
- Affiliated entity
- ACCURA HEALTHCARE
All disclosed owners & managing parties 8
| Name | Role | Since | Share |
|---|---|---|---|
| Ted a Leneave |
Operational/Managerial Control | Oct 1, 2019 | |
| Gail Sheridan |
5% Or Greater Indirect Ownership Interest | Jan 1, 1989 | 50% |
| James E Surdy |
W-2 Managing Employee |
Apr 1, 2024 | |
| Cortney Kleinsasser |
Corporate Director | Oct 1, 2019 | |
| Penny Black |
W-2 Managing Employee |
Apr 1, 2024 | |
| American Healthcare Management Services LLC |
Operational/Managerial Control | Oct 1, 2019 | 100% |
| Tealwood Enterprise Inc |
5% Or Greater Direct Ownership Interest | May 31, 2013 | 100% |
| Howard a Groff |
5% Or Greater Indirect Ownership Interest | Sep 3, 2008 | 50% |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20021010000016 | MN | Part a Provider - Skilled Nursing Facility | 7012824683 | Practice locations: Karlstad, MN |
National Provider Directory
- Tax ID family
- Karlstad Healthcare Center Inc
Locations
304 Washington Ave W
Karlstad, MN 56732
Phone (218) 436-2161
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Skilled Nursing Facility | 314000000X | 330265 | MN | Yes |
Addresses
Primary practice location
304 Washington Ave W
Karlstad, MN 56732-4018
Mailing address
304 Washington Ave W
Karlstad, MN 56732-4018
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 012028600 | Medicaid | MN | |
| NH0430 | Other | MN | UCARE |
| 8706KA | Other | MN | BLUE CROSS BLUE SHIELD |
Other providers in Karlstad, MN
- Jane Thomas Gracza
- Melanie Hartmann
- Ind School District #2358
- Karlstad Family Chiropractic
- Karlstad Family Chiropractic P.a.
- Kittson Memorial Hospital Association
- Karrah Oliver
- Jana D Riley
- Thrifty Drug Stores Inc
- Tri-County Emergency Medical Services District, Inc.
All providers in Karlstad, MN · Skilled Nursing Facility in Minnesota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 20, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.