PHS Walnut Ridge LLC
Organization Active NPI Skilled Nursing Facility · Clive, IA
NPI 1659920320 · NPPES record last updated Nov 11, 2025
Key facts
- NPI
- 1659920320
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Skilled Nursing Facility 314000000X
- Legal business name
- PHS WALNUT RIDGE LLC
- Practice address
- 1703 Campus Drive
Clive, IA 50325 - Phone
- (651) 631-6450
- Fax
- (651) 631-6122
- NPI assigned
- Sep 5, 2019
- Organization subpart
- No
Authorized official
- Name
- Mark T Meyer
- Title
- Cfo
- Phone
- (651) 631-6102
Facilities with the same owner 22
Affiliated clinicians 5
-
Tyler L Casey, MD
-
Megan Leigh Kippes, D.O.
-
Amy Jo Lamberti, PA-C
-
Jeffrey Allen Richards, D.O.
-
Sarah Christine Tallman, D.O. (AS OF 5-09)
Medicare Care Compare: Nursing home
- Listed as
- Walnut Ridge
- 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
- For profit - Limited Liability company
- Certified
- Sep 9, 2021
- Medicare certification status
- Active
- Certified beds
- 60 · 45.5 residents per day on average
- Chain
- Presbyterian Homes & Services
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 16D2177022 | PHS Walnut Ridge LLC | Certificate of waiver | Jan 1, 2028 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IA
Skilled nursing facility certification: CCN 165791
- Legal name
- PHS WALNUT RIDGE LLC
- Doing business as
- WALNUT RIDGE
- Certification status
- Active
- Provider type (POS)
- Nursing home – SNF/NF dual certification
- Participating since
- Sep 9, 2021
- Last certification
- Aug 8, 2024
- Beds
- 60
- Ownership / control type
- Limited Liability Corporation
- Organization structure
- LLC · Non-profit
- Incorporated
- Jun 18, 2012 in MN
- Enrollment address
- 1703 Campus Dr
Clive, IA 50325-6643 - Nursing home name
- WALNUT RIDGE
- Affiliated entity
- PRESBYTERIAN HOMES & SERVICES
All disclosed owners & managing parties 6
| Name | Role | Since | Share |
|---|---|---|---|
| Mark T Meyer |
Corporate Officer |
Jun 8, 2012 | 33% |
| Corporate Director |
Jun 8, 2012 | 33% | |
| Daniel a Lindh |
Corporate Officer |
Jun 8, 2012 | 33% |
| Corporate Director |
Jun 8, 2012 | 33% | |
| PHS Management, LLC |
Operational/Managerial Control | Aug 10, 2018 | 100% |
| Duane W Larson |
Corporate Officer |
Dec 10, 2019 | 33% |
| Corporate Director |
Dec 10, 2019 | 33% | |
| Bremer Bank National Association |
5% Or Greater Mortgage Interest | Aug 30, 2018 | 74% |
| 5% Or Greater Security Interest | Aug 30, 2018 | 74% | |
| Allison N Bass |
W-2 Managing Employee |
Nov 1, 2016 | |
| Operational/Managerial Control |
Nov 1, 2016 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20200406001434 | IA | Part a Provider - Skilled Nursing Facility | 6800225251 | Practice locations: Clive, IA |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Skilled Nursing Facility | 314000000X | Yes |
Addresses
Primary practice location
1703 Campus Drive
Clive, IA 50325
Mailing address
2845 Hamline Ave N
Roseville, MN 55113-7127
Phone (651) 631-6432
Other names
- PHS Walnut Ridge LLC.
- Walnut Ridge
Other providers in Clive, IA
- Todd Charles Peterson
- Karman A Pflughaupt
- Kelly Jo Pfundheller
- Janalyn Phillips
- Phippsburger Inc
- Ai Huong Phu
- Douglas Raymond Pick
- Molly Anne Pieper
- Todd Randall Pietig
- Kate Pithan
All providers in Clive, IA · Skilled Nursing Facility in Iowa
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 11, 2025. 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.