Clyde Development Inc
Organization Active NPI Skilled Nursing Facility · Clyde, KS
NPI 1629009337 · NPPES record last updated Oct 14, 2024
Key facts
- NPI
- 1629009337
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Skilled Nursing Facility 314000000X
- License
- 314000000X (KS)
- Legal business name
- CLYDE DEVELOPMENT INC
- Practice address
- 114 South High
Clyde, KS 66938-9472 - Phone
- (785) 446-2818
- Fax
- (785) 446-2288
- NPI assigned
- Jul 5, 2006
- Organization subpart
- No
Authorized official
- Name
- David L Scott, ACHA, LBSW
- Title
- Administrator/Social Worker
- Phone
- (785) 446-2518
Affiliated clinicians 5
-
Nolan Jackson Beavers, M.D,
-
Dorothy Breault, M.D.
-
Daniel J Garlow, M.D.
-
Allie B Lohrmeyer, M.D.
-
Justin M. Poore, D.O.
Medicare Care Compare: Nursing home
- Listed as
- Park Villa
- 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
- Active
- Certified beds
- 34 · 31.9 residents per day on average
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 17D0450823 | Park Villa | Certificate of waiver | Aug 31, 2026 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in KS
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
- Corporation · Non-profit
- Incorporated
- Sep 27, 1974 in KS
- Enrollment address
- 114 S High St
Clyde, KS 66938-9472 - Nursing home name
- PARK VILLA
All disclosed owners & managing parties 8
| Name | Role | Since | Share |
|---|---|---|---|
| Mary Sue Bremerman |
W-2 Managing Employee |
Feb 12, 2018 | 100% |
| Terry Koch |
Corporate Officer |
Aug 17, 2014 | |
| Heather Germann |
Corporate Director | Mar 16, 2022 | |
| W-2 Managing Employee |
Mar 16, 2022 | 100% | |
| Lawrence Blochlinger |
Corporate Director | Dec 12, 2021 | |
| W-2 Managing Employee |
Dec 12, 2021 | 100% | |
| Joseph Cassidy |
W-2 Managing Employee |
May 1, 2017 | 100% |
| William Genereux |
Corporate Officer |
Aug 17, 2014 | |
| Bruce Irwin |
W-2 Managing Employee |
Mar 1, 2017 | 100% |
| Reed Wilson |
Corporate Officer |
Aug 17, 2014 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20061003000342 | KS | Part a Provider - Skilled Nursing Facility | 5799733556 | Practice locations: Clyde, KS |
National Provider Directory
Locations
114 S High St
Clyde, KS 66938
Phone (785) 446-2818
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Skilled Nursing Facility | 314000000X | 314000000X | KS | Yes |
Addresses
Primary practice location
114 South High
Clyde, KS 66938-9472
Mailing address
114 South High
Clyde, KS 66938-9472
Phone (785) 446-2818
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 100109300A | Medicaid | KS |
Other names
- Park Villa
Other providers in Clyde, KS
- City of Clyde
- Clay Center Family Physicians PA
- Clay County Medical Center
- Stephanie Rose Girard
- Lauren Hartsook
- Cathleen Joyce Kelly
- Clara Knox
- Mod Solution LLC
All providers in Clyde, KS · Skilled Nursing Facility in Kansas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 14, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.