County of Kanabec
Organization Active NPI Public Health or Welfare Agency · Mora, MN
NPI 1669424198 · NPPES record last updated Feb 19, 2015
Key facts
- NPI
- 1669424198
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Public Health or Welfare Agency 251K00000X
- License
- 331159 (MN)
- Legal business name
- COUNTY OF KANABEC
- Practice address
- 905 Forest Ave E
Ste. 127
Mora, MN 55051-1624 - Phone
- (320) 679-6330
- Fax
- (320) 679-6333
- NPI assigned
- May 16, 2006
- Organization subpart
- No
Authorized official
- Name
- Mrs. Wendy L. Thompson, RN, PHN,
- Title
- Director
- Phone
- (320) 679-6322
Owners & managing parties with NPI records 2
Other NPIs on the same Medicare enrollment 1
Affiliated clinicians 4
-
Ryan Richard Kroschel, M.D.
Medicare Care Compare: Home health agency
- Listed as
- Kanabec County Community Health
- Overall star rating
- ★★☆☆☆ 1.5 of 5
- Ownership
- Government Operated
- Certified
- Feb 24, 1983
- Services
- Nursing, Home health aide, Physical therapy, Speech pathology, Occupational therapy
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MN
Home health agency certification: CCN 247126
- Legal name
- COUNTY OF KANABEC
- Certification status
- Active
- Provider type (POS)
- Home health agency
- Participating since
- Feb 24, 1983
- Last certification
- Dec 18, 2020
- Ownership / control type
- Government Operated
- Organization structure
- Government · Non-profit
- Incorporated
- Dec 31, 1972 in MN
- Enrollment address
- 905 Forest Ave E
Ste 127
Mora, MN 55051-1632
All disclosed owners & managing parties 4
| Name | Role | Since | Share |
|---|---|---|---|
| County of Kanabec |
5% Or Greater Direct Ownership Interest | Jan 1, 2018 | 100% |
| Rickey V Mattson |
Corporate Officer |
Jan 1, 2023 | 20% |
| Kathryn M Burski |
Corporate Director |
Jan 1, 2017 | |
| Sheila M Kientop |
W-2 Managing Employee |
Sep 8, 1992 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20100517000261 | MN | Part a Provider - Home Health Agency | 0648187237 |
1 other NPI on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Mora, MN |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Public Health or Welfare Agency | 251K00000X | 331159 | MN | Yes |
Addresses
Primary practice location
905 Forest Ave E
Ste. 127
Mora, MN 55051-1624
Mailing address
905 Forest Ave E
Suite. 127
Mora, MN 55051-1624
Phone (320) 679-6330
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 471555100 | Medicaid | MN |
Other names
- Kanabec-Pine Community Health
Other providers in Mora, MN
- Benjamin Bryan Coleman
- Renee L Coleman
- Pamela Cone
- Brooke Copeland
- County of Kanabec
- County of Kanabec
- Donald A Dahlen
- Michael D Dahlheim
- Rachel Ann Dahlquist
- Darla Danielson Anderson
All providers in Mora, MN · Public Health or Welfare Agency in Minnesota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 19, 2015. 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.