Active NPI
Divine Providence Community Home
- Skilled Nursing Facility
- Sleepy Eye, MN
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Skilled Nursing Facility
- Legal business name
- DIVINE PROVIDENCE COMMUNITY HOME
- Practice address
- 700 Third Ave NW
Sleepy Eye, MN 56085 - Phone
- (507) 794-3011
- Fax
- (507) 794-3020
- NPI assigned
- Sep 22, 2005
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mrs. Jayna Marie Groebner, LNHA
- Title
- Administrator
- Phone
- (507) 794-3011
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Skilled Nursing Facility | 314000000X | 328233 | MN | |
| Skilled Nursing Facility | 314000000X | Primary |
Addresses
Primary practice location
700 Third Ave NW
Sleepy Eye, MN 56085
Mailing address
700 Third Ave NW
Sleepy Eye, MN 56085
Phone (507) 794-3011
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 356540800 | Medicaid | MN |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MN
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20030422000059 | MN | Part A Provider - Skilled Nursing Facility | 0042129850 | Practice locations: Sleepy Eye, MN |
Skilled nursing facility certification: CCN 245599
- Legal name
- DIVINE PROVIDENCE COMMUNITY HOME
- Certification status
- Active
- Provider type (POS)
- Nursing home – SNF/NF dual certification
- Participating since
- Oct 1, 1991
- Last certification
- Mar 4, 2025
- Beds
- 50
- Ownership / control type
- Nonprofit Corporation
- Organization structure
- Corporation
- Incorporated
- Jun 1, 1977 in MN
- Enrollment address
- 700 3Rd Ave NW
Sleepy Eye, MN 56085-1036 - Nursing home name
- DIVINE PROVIDENCE COMMUNITY HOME
Care Compare: Nursing home
Medicare Care Compare- Listed as
- Divine Providence Community Home
- Overall star rating
- Health inspections
- Staffing
- Quality measures
- Type
- Medicare and Medicaid
- Ownership
- Non profit - Corporation
- Certified
- Oct 1, 1991
- Medicare certification status
- Active
- Certified beds
- 50
Laboratory certificates & supplier records
Derived by NPIMapThese CMS records do not include an NPI. They are shown because their name and street address match this provider’s.
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 24D0405117 | Divine Providence Community Home | Certificate of waiver | Aug 31, 2026 |
National Provider Directory
National Provider DirectoryLocations
700 3rd Ave NW
Sleepy Eye, MN 56085
Phone (507) 794-3011
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.
| Name | Role | Since | Share |
|---|---|---|---|
| Janet Kosman | Corporate Officer | Nov 13, 2021 | |
| Sharon Williams | Corporate Officer | Nov 13, 2021 | |
| Venkata Krishna Murthy | Operational/Managerial Control | Feb 1, 1995 | |
| Adp of the SNF | May 19, 2025 | ||
| Adp of the SNF | Jun 30, 2022 | ||
| Jayna Groebner | Operational/Managerial Control | Aug 26, 2011 | |
| Adp of the SNF | May 19, 2025 | ||
| Caryn Haas | Corporate Director | Jul 1, 2024 | |
| Margaret Ann Hubler | Corporate Director | Jul 1, 2024 | |
| Rita M Butler | Corporate Officer | Jul 1, 2024 |
Owners & managing parties with NPI records 1
Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.
-
- Surgery Physician
- Sleepy Eye, MN
- NPI 1497724892
Adp of the SNF, Operational/Managerial Control
Practitioners & affiliated clinicians
Practitioners 2
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Family Medicine Physician
- Sleepy Eye, MN
- NPI 1083810907
-
- Family Medicine Physician
- New Ulm, MN
- NPI 1609210616
Affiliated clinicians 5
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": "1127347200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1326326400000",
"number": "1538155809",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "700 THIRD AVE NW",
"city": "SLEEPY EYE",
"state": "MN",
"postal_code": "56085",
"telephone_number": "507-794-3011",
"fax_number": "507-794-3020"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "700 THIRD AVE NW",
"city": "SLEEPY EYE",
"state": "MN",
"postal_code": "56085",
"telephone_number": "507-794-3011",
"fax_number": "507-794-3020"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "DIVINE PROVIDENCE COMMUNITY HOME",
"organizational_subpart": "NO",
"enumeration_date": "2005-09-22",
"last_updated": "2012-01-12",
"status": "A",
"authorized_official_last_name": "GROEBNER",
"authorized_official_first_name": "JAYNA",
"authorized_official_middle_name": "MARIE",
"authorized_official_title_or_position": "ADMINISTRATOR",
"authorized_official_telephone_number": "507-794-3011",
"authorized_official_name_prefix": "Mrs.",
"authorized_official_credential": "LNHA"
},
"taxonomies": [
{
"code": "314000000X",
"taxonomy_group": "",
"desc": "Skilled Nursing Facility",
"state": "MN",
"license": "328233",
"primary": false
},
{
"code": "314000000X",
"taxonomy_group": "",
"desc": "Skilled Nursing Facility",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "356540800",
"state": "MN"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Sleepy Eye, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 12, 2012; 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.