NPIMap

Organization Active NPI

Bayside Manor LLC

  • Skilled Nursing Facility
  • Gaylord, MN
National Provider Identifier
1710646641
Registry record updated Dec 8, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
BAYSIDE MANOR LLC
Practice address
640 3Rd St
Gaylord, MN 55334-2297
Phone
(507) 237-2911
NPI assigned
Dec 8, 2021
Last updated
Dec 8, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 8, 2021

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

Authorized official

Name
Joshua Legum
Title
Manager
Phone
(507) 203-1001

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X Primary

Addresses

Primary practice location

640 3Rd St
Gaylord, MN 55334-2297

Mailing address

638 Southbend Ave
Mankato, MN 56001-2168

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20211227000733 MN Part A Provider - Skilled Nursing Facility 2264823400 Practice locations: Gaylord, MN

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1710646641. Details of each certification follow.

Skilled nursing facility certification: CCN 245473

Legal name
BAYSIDE MANOR LLC
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
May 1, 1987
Last certification
Oct 15, 2024
Beds
44
Ownership / control type
Limited Liability Corporation
Multi-facility organization
Monarch Health Management
Organization structure
LLCProprietary
Incorporated
Nov 30, 2021 in MN
Enrollment address
640 3Rd St
Gaylord, MN 55334-2297
Nursing home name
BAYSIDE MANOR LLC
Affiliated entity
MONARCH HEALTHCARE MANAGEMENT

Care Compare: Nursing home

Medicare Care Compare
Listed as
Bayside Manor LLCCCN 245473 · All quality measures
Overall star rating
2 of 5
Health inspections
2 of 5
Staffing
2 of 5
Quality measures
4 of 5
Type
Medicare and Medicaid
Ownership
For profit - Limited Liability company
Certified
May 1, 1987
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
4432.7 residents per day on average
Chain
Monarch Healthcare Management45 facilities in the chain
Abuse citation
Cited for abuse (Care Compare abuse icon)
Penalties (3 years)
1Fines totaling $16,982

Processed by Care Compare on Aug 1, 2026.

National Provider Directory

National Provider Directory

Locations

638 Southbend Ave
Mankato, MN 56001
Phone (507) 203-1000

Ownership & related parties

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.

NameRoleSinceShare
Spartan Healthcare LLC Organization, Chicago, IL LLC, For-profit 5% Or Greater Direct Ownership Interest May 1, 2021 32%
WBS Holdings LLC Organization, Brooklyn, NY LLC, For-profit 5% Or Greater Direct Ownership Interest May 1, 2021 22%
William Stern Individual 5% Or Greater Indirect Ownership Interest Dec 31, 2021 22%
Corporate OfficerChief Financial Officer Dec 31, 2021 22%
Marc Halpert Individual 5% Or Greater Indirect Ownership Interest Dec 31, 2021 32%
Corporate OfficerChief Operations Officer Dec 31, 2021 32%
Operational/Managerial ControlCoo Dec 31, 2021 32%
Joshua Legum Individual Contracted Managing EmployeeCeo Dec 31, 2021 32%
5% Or Greater Indirect Ownership Interest Dec 31, 2021 32%
Yazoma Holdings, LLC Organization, Skokie, IL LLC, For-profit 5% Or Greater Direct Ownership Interest Dec 31, 2021 32%
Noam Jaffa Individual 5% Or Greater Indirect Ownership Interest Dec 31, 2021 14%
Corporate DirectorDirector of Procurement Dec 31, 2021 14%
Nij LLC Organization, St Louis Park, MN LLC, For-profit 5% Or Greater Direct Ownership Interest May 1, 2021 14%

Facilities with the same owner 44

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

View all 44

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

Affiliated clinicians 1

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": "1638921600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1638921600000",
    "number": "1710646641",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "638 SOUTHBEND AVE",
            "city": "MANKATO",
            "state": "MN",
            "postal_code": "560012168"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "640 3RD ST",
            "city": "GAYLORD",
            "state": "MN",
            "postal_code": "553342297",
            "telephone_number": "507-237-2911"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BAYSIDE MANOR LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-12-08",
        "last_updated": "2021-12-08",
        "certification_date": "2021-12-08",
        "status": "A",
        "authorized_official_last_name": "LEGUM",
        "authorized_official_first_name": "JOSHUA",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "507-203-1001"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Gaylord, MN

Sources for this page

Verify at the official NPI Registry.