NPIMap

Organization Active NPI

McKenzie County Healthcare Systems Inc

Doing business as Good Shepherd Home

  • Skilled Nursing Facility
  • Watford City, ND
National Provider Identifier
1619998358
Registry record updated Jun 16, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
MCKENZIE COUNTY HEALTHCARE SYSTEMS INC
Doing business as
Good Shepherd Home
Practice address
709 4TH Ave NE
Watford City, ND 58854-7628
Phone
(701) 444-2331
Fax
(701) 444-4629
NPI assigned
Jul 21, 2006
Last updated
Jun 16, 2023By the provider in NPPES
Organization subpart
Yes
Parent organization
MCKENZIE COUNTY HEALTHCARE SYSTEMS INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jun 16, 2023

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

Authorized official

Name
Rebecca Lynn Blahoski
Title
Clinic Director
Phone
(701) 444-8746

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X NU Primary

Addresses

Primary practice location

709 4TH Ave NE
Watford City, ND 58854-7628

Mailing address

709 4TH Ave NE
Watford City, ND 58854-7628
Phone (701) 444-2331

Other identifiers 1

IdentifierTypeStateIssuer
30449MedicaidND

Other names 1

  • Good Shepherd Home Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20071220000525 ND Part A Provider - Skilled Nursing Facility 5890768006 Practice locations: Watford City, ND

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1619998358. Details of each certification follow.

Skilled nursing facility certification: CCN 355072

Legal name
MCKENZIE COUNTY HEALTHCARE SYSTEMS INC
Doing business as
GOOD SHEPHERD HOME
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Sep 1, 1978
Last certification
Jun 20, 2024
Beds
42
Ownership / control type
Nonprofit Corporation
Organization structure
CorporationNon-profit
Incorporated
Jul 1, 2004 in ND
Enrollment address
709 4TH Ave NE
Watford City, ND 58854-7628
Nursing home name
MCKENZIE COUNTY HEALTHCARE SYSTEMS LONG TERM CARE

Other NPIs with the same Medicare PAC ID 4

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

Care Compare: Nursing home

Medicare Care Compare
Listed as
McKenzie County Healthcare Systems Long Term CareCCN 355072 · All quality measures
Overall star rating
3 of 5
Health inspections
3 of 5
Staffing
4 of 5
Quality measures
3 of 5
Type
Medicare and Medicaid
Ownership
Non profit - Corporation
Certified
Sep 1, 1978
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
4238.2 residents per day on average

Processed by Care Compare on Aug 1, 2026.

National Provider Directory

National Provider Directory
Tax ID family
McKenzie County Healthcare12 organizations share this tax ID, including this one
Part of
McKenzie County Healthcare

Other organizations with this tax ID 11

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

Locations

709 4th Ave NE
Watford City, ND 58854
Phone (701) 444-2331

Ownership & related parties

All disclosed owners & managing parties 13

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

NameRoleSinceShare
Amanda J Loughman Individual Corporate OfficerController Jun 9, 2025
Cheryl L Faulkner Individual Corporate DirectorCon Jul 1, 2004
Adp of the SNF Apr 23, 2025
Chase Wisness Individual Corporate DirectorDirector Jan 1, 2022
Gary Brown Individual Corporate DirectorBoard Director Jan 1, 2020
Peter Edis Individual Corporate OfficerCeo Dec 31, 2021
Operational/Managerial Control Dec 31, 2021
Adp of the SNF Apr 23, 2025
Monty Bulzomi Individual Corporate DirectorBoard Director Jan 1, 2020
Randy Quale Individual Corporate DirectorDirector Apr 27, 2021
Jan Dodge Individual Corporate DirectorBoard Director Jan 1, 2020
McKenzie County Healthcare Systems Inc Organization, Watford City, ND Corporation, Non-profit 5% Or Greater Direct Ownership Interest Jul 1, 2004 100%
William S Merkle Individual Corporate OfficerCfo Aug 1, 2023
Corporate DirectorBoard Director Aug 1, 2023
Justin Voll Individual Corporate DirectorBoard Member Jan 1, 2020
Virginia E Ceynar Individual Corporate DirectorBoard Director Jan 1, 2020
Krista Heen Individual Corporate Director Jan 30, 2024

Owners & managing parties with NPI records 4

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

All facility ownership & control disclosures 3

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
McKenzie County Healthcare Systems IncWatford City, ND, CCN 351302 Hospital 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Jul 1, 2004
Jul 1, 2004
McKenzie County HospitalWatford City, ND, CCN 35Z302 Hospital 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control (100%)		 Jul 1, 2004
Jul 1, 2004
MCHS ClinicWatford City, ND, CCN 353438 Rural health clinic 5% Or Greater Direct Ownership Interest
Operational/Managerial Control		 Jul 1, 2004
Jul 1, 2004

Owned or controlled facilities with NPI records 3

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Facilities with the same owner 3

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

Practitioners & affiliated clinicians

Practitioners 47

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.

View all 47

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": "1153440000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1686873600000",
    "number": "1619998358",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "709 4TH AVE NE",
            "city": "WATFORD CITY",
            "state": "ND",
            "postal_code": "588547628",
            "telephone_number": "701-444-2331",
            "fax_number": "701-444-4629"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "709 4TH AVE NE",
            "city": "WATFORD CITY",
            "state": "ND",
            "postal_code": "588547628",
            "telephone_number": "701-444-2331",
            "fax_number": "701-444-4629"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MCKENZIE COUNTY HEALTHCARE SYSTEMS INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MCKENZIE COUNTY HEALTHCARE SYSTEMS INC",
        "enumeration_date": "2006-07-21",
        "last_updated": "2023-06-16",
        "certification_date": "2023-06-16",
        "status": "A",
        "authorized_official_last_name": "BLAHOSKI",
        "authorized_official_first_name": "REBECCA",
        "authorized_official_middle_name": "LYNN",
        "authorized_official_title_or_position": "CLINIC DIRECTOR",
        "authorized_official_telephone_number": "701-444-8746"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "30449",
            "state": "ND"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Good Shepherd Home",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Good Shepherd Home",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Watford City, ND

Sources for this page

Verify at the official NPI Registry.