Parkside Home

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

1081A Issued in ND

Legal business name

PARKSIDE HOME

Doing business as

Parkside Lutheran Home, Inc.

Practice address

501 - 3Rd Ave West
Lisbon, ND 58054-0153

Phone

(701) 683-5239

Fax

(701) 683-4109

NPI assigned

Jun 9, 2005

Last updated

Jul 10, 2007By 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

Mr. Wayne Hendrickson

Title

Administrator

Phone

(701) 683-5239

Specialties & licenses 1

Addresses

Other names 1

• Parkside Lutheran Home, Inc. Doing business as

Medicare fee-for-service enrollment

Enrolled in ND

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1487658324. Details of each certification follow.

• CCN 355116 Skilled nursing facility · Active · Details

Skilled nursing facility certification: CCN 355116

Legal name

PARKSIDE HOME

Doing business as

PARKSIDE LUTHERAN HOME

Certification status

Active

Provider type (POS)

Nursing home – SNF/NF dual certification

Participating since

Jan 1, 1992

Last certification

Aug 8, 2024

Beds

40

Ownership / control type

Nonprofit Corporation

Organization structure

CorporationNon-profit

Enrollment address

501 3Rd Ave W
Lisbon, ND 58054-4053

Nursing home name

PARKSIDE LUTHERAN HOME

Listed as

Parkside Lutheran HomeCCN 355116 · All quality measures

Overall star rating

1 of 5

Health inspections

2 of 5

Staffing

1 of 5

Quality measures

4 of 5

Type

Medicare and Medicaid

Ownership

Non profit - Corporation

Certified

Jan 1, 1992

Medicare certification status

ActiveFrom the Provider of Services file

Certified beds

4036.2 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 10

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 1

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

• Tara Renae Mertz-Hack, MD

  • Family Medicine Physician
  • Oakes, ND
  • NPI 1245641489

  Adp of the SNF, Corporate Officer, Operational/Managerial Control

  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.

• Andrew Herting, MD

  • Internal Medicine Physician
  • Valley City, ND
  • NPI 1841867074
  NPD (past)
• Hima Bindu Kondragunta

  • Internal Medicine Physician
  • Lisbon, ND
  • NPI 1760985584
  NPD (past)
• Tara Renae Mertz-Hack, MD

  • Family Medicine Physician
  • Oakes, ND
  • NPI 1245641489
  NPD (past)

Affiliated clinicians 1

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

• Andrew Herting, MD

  • Internal Medicine Physician
  • Valley City, ND
  • NPI 1841867074

  Nursing home

  Care Compare affiliation

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

{
    "created_epoch": "1118275200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1184025600000",
    "number": "1487658324",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "501 - 3RD AVE WEST",
            "city": "LISBON",
            "state": "ND",
            "postal_code": "580540153",
            "telephone_number": "701-683-5239",
            "fax_number": "701-683-4109"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "501 - 3RD AVE WEST",
            "city": "LISBON",
            "state": "ND",
            "postal_code": "580540153",
            "telephone_number": "701-683-5239",
            "fax_number": "701-683-4109"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PARKSIDE HOME",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-06-09",
        "last_updated": "2007-07-10",
        "status": "A",
        "authorized_official_last_name": "HENDRICKSON",
        "authorized_official_first_name": "WAYNE",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "701-683-5239",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "ND",
            "license": "1081A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Parkside Lutheran Home, Inc.",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Skilled Nursing Facility in Lisbon, ND
• Providers in Lisbon, ND by specialty
• Skilled Nursing Facility in North Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 2007; 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.