NPIMap

Organization Active NPI

Karlstad Healthcare Center, Inc

  • Skilled Nursing Facility
  • Karlstad, MN
National Provider Identifier
1477541951
Registry record updated Oct 20, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
330265 Issued in 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
Last updated
Oct 20, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 20, 2008

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

Authorized official

Name
Howie Groff
Title
President
Phone
(952) 888-2923

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X 330265 MN Primary

Addresses

Primary practice location

304 Washington Ave W
Karlstad, MN 56732-4018

Mailing address

304 Washington Ave W
Karlstad, MN 56732-4018

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20021010000016 MN Part A Provider - Skilled Nursing Facility 7012824683 Practice locations: Karlstad, MN

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1477541951. Details of each certification follow.

Skilled nursing facility certification: CCN 245468B

Legal name
KARLSTAD HEALTHCARE CENTER, INC
Organization structure
CorporationProprietary
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

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
24D0893772Karlstad Healthcare Center Inc304 Washington Avenue W, Karlstad, MN 56732Certificate of waiverOct 27, 2026

National Provider Directory

National Provider Directory
Tax ID family
Karlstad Healthcare Center Inc2 organizations share this tax ID, including this one

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 8

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

NameRoleSinceShare
Ted a Leneave Individual Operational/Managerial Control Oct 1, 2019
Gail Sheridan Individual 5% Or Greater Indirect Ownership Interest Jan 1, 1989 50%
James E Surdy Individual W-2 Managing EmployeeMD; Apr 1, 2024
Cortney Kleinsasser Individual Corporate Director Oct 1, 2019
Penny Black Individual W-2 Managing EmployeeAd; Apr 1, 2024
American Healthcare Management Services LLC Organization, West Des Moines, IA LLC, Management services company Operational/Managerial Control Oct 1, 2019 100%
Tealwood Enterprise Inc Organization, Bloomington, MN For-profit 5% Or Greater Direct Ownership Interest May 31, 2013 100%
Howard a Groff Individual 5% Or Greater Indirect Ownership Interest Sep 3, 2008 50%

Owners & managing parties with NPI records 1

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

Facilities with the same owner 8

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

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": "1128902400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1224460800000",
    "number": "1477541951",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "304 WASHINGTON AVE W",
            "city": "KARLSTAD",
            "state": "MN",
            "postal_code": "567324018"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "304 WASHINGTON AVE W",
            "city": "KARLSTAD",
            "state": "MN",
            "postal_code": "567324018",
            "telephone_number": "218-436-2161"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KARLSTAD HEALTHCARE CENTER, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-10",
        "last_updated": "2008-10-20",
        "status": "A",
        "authorized_official_last_name": "GROFF",
        "authorized_official_first_name": "HOWIE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "952-888-2923"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "MN",
            "license": "330265",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Karlstad, MN

Sources for this page

Verify at the official NPI Registry.