NPIMap

Organization Active NPI

Charlevoix Nursing Home Corporation

Doing business as Boulder Park Terrace

  • Nursing Facility/Intermediate Care Facility
  • Charlevoix, MI
National Provider Identifier
1508962069
Registry record updated Aug 28, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nursing Facility/Intermediate Care FacilityTaxonomy code 313M00000X
License
235526 Issued in MI
Legal business name
CHARLEVOIX NURSING HOME CORPORATION
Doing business as
Boulder Park Terrace
Practice address
14676 W Upright St
Charlevoix, MI 49720-1201
Phone
(231) 547-1005
NPI assigned
Sep 15, 2006
Last updated
Aug 28, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 28, 2017

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

Authorized official

Name
Mr. David Bellamy
Title
Cfo
Phone
(231) 487-4094

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nursing Facility/Intermediate Care Facility 313M00000X 235526 MI Primary

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 names 1

  • Boulder Park Terrace Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120518000435 MI Part A Provider - Skilled Nursing Facility 9032378534 Practice locations: Charlevoix, MI

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1508962069. Details of each certification follow.

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
CorporationNon-profit
Incorporated
Jun 10, 1992 in MI
Enrollment address
14676 W Upright St
Charlevoix, MI 49720-1201
Nursing home name
BOULDER PARK TERRACE

Care Compare: Nursing home

Medicare Care Compare
Listed as
Boulder Park TerraceCCN 235526 · All quality measures
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
ActiveFrom the Provider of Services file
Certified beds
7248.7 residents per day on average
Abuse citation
Cited for abuse (Care Compare abuse icon)
Penalties (3 years)
2Fines totaling $0

Processed by Care Compare on Aug 1, 2026.

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
23D0708812Boulder Park Terrace14676 West Upright Avenue, Charlevoix, MI 49720Certificate of waiverAug 31, 2026

National Provider Directory

National Provider Directory

Member of 2

Organizations this organization is a member of, according to the National Provider Directory.

Ownership & related parties

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.

NameRoleSinceShare
Joanne Schroeder Individual Corporate OfficerVice-Chairman Jun 19, 2017
Trustee of the SNF Jun 19, 2017
Munson Healthcare Charlevoix Hospital Organization, Charlevoix, MI Non-profit 5% Or Greater Direct Ownership Interest Jun 10, 1992 25%
Philip a Incarnati Individual Corporate OfficerPresident/Ceo MHC Sep 16, 2025
Trustee of the SNF Sep 16, 2025
Garfield H Atchison Individual Corporate OfficerPresident/Ceo 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 Organization, Grand Blanc, MI Corporation, Non-profit, Chain home office Adp of the SNF Sep 16, 2025
Indirect Ownership Interest Jan 1, 2013 100%
Cathy a Wonski Individual Corporate DirectorTrustee 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 Individual Corporate OfficerVP/Cfo 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 Individual Corporate DirectorTrustee 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 Organization, Petoskey, MI Corporation 5% Or Greater Direct Ownership Interest Jan 1, 2013 75%

Owners & managing parties with NPI records 11

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

Practitioners & affiliated clinicians

Practitioners 2

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.

Affiliated clinicians 1

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

NPI Registry JSON

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

{
    "created_epoch": "1158278400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1503878400000",
    "number": "1508962069",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14676 W UPRIGHT ST",
            "city": "CHARLEVOIX",
            "state": "MI",
            "postal_code": "497201201",
            "telephone_number": "231-547-1005"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14676 W UPRIGHT ST",
            "city": "CHARLEVOIX",
            "state": "MI",
            "postal_code": "497201201",
            "telephone_number": "231-547-1005"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHARLEVOIX NURSING HOME CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-15",
        "last_updated": "2017-08-28",
        "status": "A",
        "authorized_official_last_name": "BELLAMY",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "231-487-4094",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "313M00000X",
            "taxonomy_group": "",
            "desc": "Nursing Facility/Intermediate Care Facility",
            "state": "MI",
            "license": "235526",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Boulder Park Terrace",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Charlevoix, MI

Sources for this page

Verify at the official NPI Registry.