NPIMap

Organization Active NPI

PHS Walnut Ridge LLC

  • Skilled Nursing Facility
  • Clive, IA
National Provider Identifier
1659920320
Registry record updated Nov 11, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
PHS WALNUT RIDGE LLC
Doing business as
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
Last updated
Nov 11, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 11, 2025

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

Authorized official

Name
Mark T Meyer
Title
Cfo
Phone
(651) 631-6102

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X Primary

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 2

  • PHS Walnut Ridge LLC. Doing business as
  • Walnut Ridge Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200406001434 IA Part A Provider - Skilled Nursing Facility 6800225251 Practice locations: Clive, IA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1659920320. Details of each certification follow.

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
LLCNon-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

Care Compare: Nursing home

Medicare Care Compare
Listed as
Walnut RidgeCCN 165791 · 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
For profit - Limited Liability company
Certified
Sep 9, 2021
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
6045.5 residents per day on average
Chain
Presbyterian Homes & Services21 facilities in the chain

Processed by Care Compare on Aug 1, 2026.

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
16D2177022PHS Walnut Ridge LLC1703 Campus Drive, Clive, IA 50325Certificate of waiverJan 1, 2028

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 6

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

NameRoleSinceShare
Mark T Meyer Individual Corporate OfficerSecretary/Treasurer Jun 8, 2012 33%
Corporate DirectorBoard Member Jun 8, 2012 33%
Daniel a Lindh Individual Corporate OfficerCeo Jun 8, 2012 33%
Corporate DirectorBoard Member Jun 8, 2012 33%
PHS Management, LLC Organization, Roseville, MN LLC, Non-profit Operational/Managerial Control Aug 10, 2018 100%
Duane W Larson Individual Corporate OfficerVice Chair Dec 10, 2019 33%
Corporate DirectorBoard Member Dec 10, 2019 33%
Bremer Bank National Association Organization, Minneapolis, MN Corporation, For-profit 5% Or Greater Mortgage Interest Aug 30, 2018 74%
5% Or Greater Security Interest Aug 30, 2018 74%
Allison N Bass Individual W-2 Managing EmployeeCampus Administrator Nov 1, 2016
Operational/Managerial ControlCampus Administrator Nov 1, 2016

Facilities with the same owner 22

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

View all 22

Practitioners & affiliated clinicians

Affiliated clinicians 5

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": "1567641600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1762819200000",
    "number": "1659920320",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2845 HAMLINE AVE N",
            "city": "ROSEVILLE",
            "state": "MN",
            "postal_code": "551137127",
            "telephone_number": "651-631-6432",
            "fax_number": "651-631-6122"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1703 CAMPUS DRIVE",
            "city": "CLIVE",
            "state": "IA",
            "postal_code": "50325",
            "telephone_number": "651-631-6450",
            "fax_number": "651-631-6122"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHS WALNUT RIDGE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-09-05",
        "last_updated": "2025-11-11",
        "certification_date": "2025-11-11",
        "status": "A",
        "authorized_official_last_name": "MEYER",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "651-631-6102"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PHS Walnut Ridge LLC.",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Walnut Ridge",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Clive, IA

Sources for this page

Verify at the official NPI Registry.