Charlevoix Nursing Home Corporation
Organization Active NPI Nursing Facility/Intermediate Care Facility · Charlevoix, MI
NPI 1508962069 · NPPES record last updated Aug 28, 2017
Key facts
- NPI
- 1508962069
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Nursing Facility/Intermediate Care Facility 313M00000X
- License
- 235526 (MI)
- Legal business name
- CHARLEVOIX NURSING HOME CORPORATION
- Practice address
- 14676 W Upright St
Charlevoix, MI 49720-1201 - Phone
- (231) 547-1005
- NPI assigned
- Sep 15, 2006
- Organization subpart
- No
Authorized official
- Name
- Mr. David Bellamy
- Title
- Cfo
- Phone
- (231) 487-4094
Owners & managing parties with NPI records 11
Member of 2
Practitioners 2
-
Dennis Feihel, MD
Affiliated clinicians 1
-
Dennis Feihel, MD
Medicare Care Compare: Nursing home
- Listed as
- Boulder Park Terrace
- Overall star rating
- ★☆☆☆☆ 1 of 5
- Health inspections
- ★☆☆☆☆ 1 of 5
- Staffing
- ★☆☆☆☆ 1 of 5
- Quality measures
- ★★★☆☆ 3 of 5
- Type
- Medicare and Medicaid
- Ownership
- Non profit - Corporation
- Certified
- Aug 14, 1992
- Medicare certification status
- Active
- Certified beds
- 72 · 48.7 residents per day on average
- Abuse citation
- Cited for abuse (Care Compare abuse icon)
- Penalties (3 years)
- 2 · fines totaling $0
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 23D0708812 | Boulder Park Terrace | Certificate of waiver | Aug 31, 2026 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MI
Skilled nursing facility certification: CCN 235526
- Legal name
- CHARLEVOIX NURSING HOME CORPORATION
- Doing business as
- BOULDER PARK TERRACE
- Certification status
- Active
- Provider type (POS)
- Nursing home – SNF/NF dual certification
- Participating since
- Aug 14, 1992
- Last certification
- Jun 5, 2025
- Beds
- 72
- Ownership / control type
- Nonprofit Corporation
- Multi-facility organization
- Charlevoix Nursing Home Corp
- Organization structure
- Corporation · Non-profit
- Incorporated
- Jun 10, 1992 in MI
- Enrollment address
- 14676 W Upright St
Charlevoix, MI 49720-1201 - Nursing home name
- BOULDER PARK TERRACE
All disclosed owners & managing parties 9
| Name | Role | Since | Share |
|---|---|---|---|
| Joanne Schroeder |
Corporate Officer |
Jun 19, 2017 | |
| Trustee of the SNF | Jun 19, 2017 | ||
| Munson Healthcare Charlevoix Hospital |
5% Or Greater Direct Ownership Interest | Jun 10, 1992 | 25% |
| Philip a Incarnati |
Corporate Officer |
Sep 16, 2025 | |
| Trustee of the SNF | Sep 16, 2025 | ||
| Garfield H Atchison |
Corporate Officer |
Nov 27, 2023 | |
| Operational/Managerial Control | Nov 27, 2023 | ||
| Trustee of the SNF | Nov 27, 2023 | ||
| Adp of the SNF | Nov 27, 2023 | ||
| McLaren Health Care Corporation |
Adp of the SNF | Sep 16, 2025 | |
| Indirect Ownership Interest | Jan 1, 2013 | 100% | |
| Cathy a Wonski |
Corporate Director |
Aug 1, 2025 | |
| Operational/Managerial Control | Aug 1, 2025 | ||
| Trustee of the SNF | Aug 1, 2025 | ||
| Adp of the SNF | Sep 16, 2025 | ||
| Michael Prusaitis |
Corporate Officer |
Mar 29, 2021 | |
| Operational/Managerial Control | Mar 29, 2021 | ||
| Trustee of the SNF | Mar 29, 2021 | ||
| Adp of the SNF | Mar 29, 2021 | ||
| Elizabeth McClellan |
Corporate Director |
Aug 1, 2025 | |
| Operational/Managerial Control | Aug 1, 2025 | ||
| Trustee of the SNF | Aug 1, 2025 | ||
| Adp of the SNF | Aug 1, 2025 | ||
| McLaren Northern Michigan |
5% Or Greater Direct Ownership Interest | Jan 1, 2013 | 75% |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20120518000435 | MI | Part a Provider - Skilled Nursing Facility | 9032378534 | Practice locations: Charlevoix, MI |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nursing Facility/Intermediate Care Facility | 313M00000X | 235526 | MI | Yes |
Addresses
Primary practice location
14676 W Upright St
Charlevoix, MI 49720-1201
Mailing address
14676 W Upright St
Charlevoix, MI 49720-1201
Phone (231) 547-1005
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2896882 | Medicaid | MI |
Other names
- Boulder Park Terrace
Other providers in Charlevoix, MI
- Charlevoix Area Hospital
- Charlevoix Commons Apothecary, LTD
- Charlevoix County Coa
- Charlevoix Eye Center, P.C.
- Charlevoix Family Dentistry PLC
- Charlevoix Physicians Clinic
- Charlevoix Senior Citizens Center, Inc
- Charlevoix-Emmet Intermediate School District
- Julie Chellis
- Mel Choponis
All providers in Charlevoix, MI · Nursing Facility/Intermediate Care Facility in Michigan
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 28, 2017. 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.