Clyde Development Inc

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

314000000X Issued in KS

Legal business name

CLYDE DEVELOPMENT INC

Doing business as

Park Villa

Practice address

114 South High
Clyde, KS 66938-9472

Phone

(785) 446-2818

Fax

(785) 446-2288

NPI assigned

Jul 5, 2006

Last updated

Oct 14, 2024By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

David L Scott, ACHA, LBSW

Title

Administrator/Social Worker

Phone

(785) 446-2518

Specialties & licenses 1

Addresses

Other names 1

• Park Villa Doing business as

Medicare fee-for-service enrollment

Enrolled in KS

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1629009337. Details of each certification follow.

• CCN 175492 Skilled nursing facility · Active · Details

Skilled nursing facility certification: CCN 175492

Legal name

CLYDE DEVELOPMENT INC

Doing business as

PARK VILLA

Certification status

Active

Provider type (POS)

Nursing home – SNF/NF dual certification

Participating since

Sep 28, 2007

Last certification

Jul 24, 2024

Beds

35 (34 certified)

Ownership / control type

Nonprofit Corporation

Organization structure

CorporationNon-profit

Incorporated

Sep 27, 1974 in KS

Enrollment address

114 S High St
Clyde, KS 66938-9472

Nursing home name

PARK VILLA

Listed as

Park VillaCCN 175492 · All quality measures

Overall star rating

5 of 5

Health inspections

4 of 5

Staffing

5 of 5

Quality measures

3 of 5

Type

Medicare and Medicaid

Ownership

Non profit - Corporation

Certified

Sep 28, 2007

Medicare certification status

ActiveFrom the Provider of Services file

Certified beds

3431.9 residents per day on average

Processed by Care Compare on Aug 1, 2026.

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

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.

Affiliated clinicians 5

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

• Nolan Jackson Beavers, M.D,

  • Family Medicine Physician
  • Belleville, KS
  • NPI 1104921782

  Nursing home

  Care Compare affiliation
• Dorothy Breault, M.D.

  • Family Medicine Physician
  • Concordia, KS
  • NPI 1245458256

  Nursing home

  Care Compare affiliation
• Daniel J Garlow, M.D.

  • Family Medicine Physician
  • Concordia, KS
  • NPI 1730470097

  Nursing home

  Care Compare affiliation
• Allie B Lohrmeyer, M.D.

  • Family Medicine Physician
  • Clay Center, KS
  • NPI 1225472418

  Nursing home

  Care Compare affiliation
• Justin M. Poore, D.O.

  • Family Medicine Physician
  • Concordia, KS
  • NPI 1306849161

  Nursing home

  Care Compare affiliation

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

{
    "created_epoch": "1152057600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1728864000000",
    "number": "1629009337",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "114 SOUTH HIGH",
            "city": "CLYDE",
            "state": "KS",
            "postal_code": "669389472",
            "telephone_number": "785-446-2818",
            "fax_number": "785-446-2288"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "114 SOUTH HIGH",
            "city": "CLYDE",
            "state": "KS",
            "postal_code": "669389472",
            "telephone_number": "785-446-2818",
            "fax_number": "785-446-2288"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CLYDE DEVELOPMENT INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-05",
        "last_updated": "2024-10-14",
        "certification_date": "2024-10-14",
        "status": "A",
        "authorized_official_last_name": "SCOTT",
        "authorized_official_first_name": "DAVID",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "ADMINISTRATOR/SOCIAL WORKER",
        "authorized_official_telephone_number": "785-446-2518",
        "authorized_official_credential": "ACHA, LBSW"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "KS",
            "license": "314000000X",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Park Villa",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Park Villa",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• City of Clyde (Clyde Community Ambulance Service)
• Clay Center Family Physicians PA (Clyde Family Physicians)
• Clay County Medical Center (Clyde Family Physicians)
• Stephanie Rose Girard, SLP
• Lauren Hartsook, CCC-SLP
• Cathleen Joyce Kelly, OTRL
• Clara Knox
• Mod Solution LLC

• Skilled Nursing Facility in Clyde, KS
• Providers in Clyde, KS by specialty
• Skilled Nursing Facility in Kansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 14, 2024; 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.

Verify at the official NPI Registry.