NPIMap

Organization Active NPI

Deer River Healthcare Center Inc

  • Skilled Nursing Facility
  • Deer River, MN
National Provider Identifier
1609989326
Registry record updated Apr 7, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
331919 Issued in MN
Legal business name
DEER RIVER HEALTHCARE CENTER INC
Practice address
115 10TH Ave NE
Deer River, MN 56636-8795
Phone
(218) 246-2900
Fax
(218) 246-3057
NPI assigned
Aug 16, 2006
Organization subpart
Yes
Parent organization
ST. MARY'S DULUTH CLINIC HEALTH SYSTEMAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 7, 2022

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

Authorized official

Name
Kevin Boren
Title
Cfo
Phone
(218) 786-1009

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X 331919 MN Primary

Addresses

Primary practice location

115 10TH Ave NE
Deer River, MN 56636-8795

Mailing address

115 10TH Ave NE
Deer River, MN 56636-8795
Phone (218) 246-2900

Other identifiers 5

IdentifierTypeStateIssuer
5025365OtherMNMEDICA
1609989326MedicaidMN
1604EOtherMNBLUE CROSS
1021626OtherMNPREFERRED ONE
300367OtherMNUCARE

Other names 1

  • Essentia Health Homestead Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20120306000921 MN Part A Provider - Skilled Nursing Facility 1850388448 Practice locations: Deer River, MN

Skilled nursing facility certification: CCN 245428

Legal name
DEER RIVER HEALTHCARE CENTER INC
Doing business as
ESSENTIA HEALTH HOMESTEAD
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Feb 1, 1987
Last certification
Mar 12, 2025
Beds
32
Ownership / control type
Nonprofit Corporation
Multi-facility organization
Essentia Health
Organization structure
CorporationNon-profit
Incorporated
Feb 13, 1956 in MN
Enrollment address
115 10TH Ave NE
Deer River, MN 56636-8795
Nursing home name
ESSENTIA HEALTH HOMESTEAD
Affiliated entity
ESSENTIA HEALTH

Other NPIs with the same Medicare PAC ID 2

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Care Compare: Nursing home

Medicare Care Compare
Listed as
Essentia Health HomesteadCCN 245428
Overall star rating
2 of 5
Health inspections
1 of 5
Staffing
5 of 5
Quality measures
4 of 5
Type
Medicare and Medicaid
Ownership
Non profit - Corporation
Certified
Feb 1, 1987
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
3220.8 residents per day on average
Chain
Essentia Health6 facilities in the chain
Penalties (3 years)
2Fines totaling $67,727

Processed by Care Compare on Aug 1, 2026.

National Provider Directory

National Provider Directory
Tax ID family
Comm Mem Hosp ER Phys4 organizations share this tax ID, including this one
Part of
St Marys Duluth Clinic Health System

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

Member of 1

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

Ownership & related parties

All disclosed owners & managing parties 18

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

NameRoleSinceShare
Krista Ann Skorupa Individual Corporate OfficerPresident May 6, 2024
Amy Bergstrom Individual Corporate DirectorBoard Member Jan 1, 2024
Anthony Sertich Individual Corporate OfficerBoard Member Jan 1, 2021
George Loban Individual Corporate DirectorBoard Member Jan 1, 2024
Jared E Lund Individual Corporate DirectorMedical Director Jan 1, 2024
Adp of the SNF Jan 1, 2024
Adam Bachand Individual Corporate DirectorBoard Member Jan 1, 2025
Thomas Jamar Individual Corporate DirectorBoard Member Jan 1, 2023
Deborah Meyer Individual Operational/Managerial Control Jul 22, 2019
Adp of the SNF Jul 22, 2019
Rebecca Urbanski Individual Corporate DirectorBoard Member Jan 1, 2025
Anthony Yung Individual Corporate DirectorBoard Member Jan 1, 2023
Essentia Health Organization, Duluth, MN Non-profit 5% Or Greater Direct Ownership Interest Mar 1, 2025 100%
Adp of the SNF May 12, 2025
Justin Terch Individual Corporate DirectorBoard Member Oct 22, 2025
St Marys Duluth Clinic Health System Organization, Duluth, MN Non-profit Operational/Managerial Control Sep 1, 2012
Adp of the SNF May 12, 2025
Kevin S Boren Individual Corporate OfficerVP of Finance Apr 4, 2022
Adp of the SNF Apr 4, 2022
Troy Duininck Individual Corporate DirectorBoard Member Jan 1, 2023
Michael Watters Individual Corporate DirectorSecretary Jul 1, 2023
Bruce Smith Individual Corporate DirectorBoard Member Jan 1, 2026
Nancy Aronson Norr Individual Corporate DirectorBoard Member Jan 1, 2025

Owners & managing parties with NPI records 6

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

Facilities with the same owner 46

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

View all 46

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1155686400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1649289600000",
    "number": "1609989326",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "115 10TH AVE NE",
            "city": "DEER RIVER",
            "state": "MN",
            "postal_code": "566368795",
            "telephone_number": "218-246-2900",
            "fax_number": "218-246-3013"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "115 10TH AVE NE",
            "city": "DEER RIVER",
            "state": "MN",
            "postal_code": "566368795",
            "telephone_number": "218-246-2900",
            "fax_number": "218-246-3057"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DEER RIVER HEALTHCARE CENTER INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ST. MARY'S DULUTH CLINIC HEALTH SYSTEM",
        "enumeration_date": "2006-08-16",
        "last_updated": "2022-04-07",
        "certification_date": "2022-04-07",
        "status": "A",
        "authorized_official_last_name": "BOREN",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "218-786-1009"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "MN",
            "license": "331919",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICA",
            "identifier": "5025365",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1609989326",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "1604E",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PREFERRED ONE",
            "identifier": "1021626",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UCARE",
            "identifier": "300367",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Essentia Health Homestead",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Essentia Health Homestead",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Deer River, MN

Sources for this page

Verify at the official NPI Registry.