Bayside Manor LLC
Organization Active NPI Skilled Nursing Facility · Gaylord, MN
NPI 1710646641 · NPPES record last updated Dec 8, 2021
Key facts
- NPI
- 1710646641
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Skilled Nursing Facility 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
- Organization subpart
- No
Authorized official
- Name
- Joshua Legum
- Title
- Manager
- Phone
- (507) 203-1001
Facilities with the same owner 44
Practitioners 2
-
Richard Luboga Byakika, M.D.
Affiliated clinicians 1
-
Richard Luboga Byakika, M.D.
Medicare Care Compare: Nursing home
- Listed as
- Bayside Manor LLC
- 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
- Active
- Certified beds
- 44 · 32.7 residents per day on average
- Chain
- Monarch Healthcare Management
- Abuse citation
- Cited for abuse (Care Compare abuse icon)
- Penalties (3 years)
- 1 · fines totaling $16,982
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MN
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
- LLC · Proprietary
- 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
All disclosed owners & managing parties 8
| Name | Role | Since | Share |
|---|---|---|---|
| Spartan Healthcare LLC |
5% Or Greater Direct Ownership Interest | May 1, 2021 | 32% |
| WBS Holdings LLC |
5% Or Greater Direct Ownership Interest | May 1, 2021 | 22% |
| William Stern |
5% Or Greater Indirect Ownership Interest | Dec 31, 2021 | 22% |
| Corporate Officer |
Dec 31, 2021 | 22% | |
| Marc Halpert |
5% Or Greater Indirect Ownership Interest | Dec 31, 2021 | 32% |
| Corporate Officer |
Dec 31, 2021 | 32% | |
| Operational/Managerial Control |
Dec 31, 2021 | 32% | |
| Joshua Legum |
Contracted Managing Employee |
Dec 31, 2021 | 32% |
| 5% Or Greater Indirect Ownership Interest | Dec 31, 2021 | 32% | |
| Yazoma Holdings, LLC |
5% Or Greater Direct Ownership Interest | Dec 31, 2021 | 32% |
| Noam Jaffa |
5% Or Greater Indirect Ownership Interest | Dec 31, 2021 | 14% |
| Corporate Director |
Dec 31, 2021 | 14% | |
| Nij LLC |
5% Or Greater Direct Ownership Interest | May 1, 2021 | 14% |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20211227000733 | MN | Part a Provider - Skilled Nursing Facility | 2264823400 | Practice locations: Gaylord, MN |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Skilled Nursing Facility | 314000000X | Yes |
Addresses
Primary practice location
640 3Rd St
Gaylord, MN 55334-2297
Mailing address
638 Southbend Ave
Mankato, MN 56001-2168
Other providers in Gaylord, MN
- Addiction Counseling Treatment Services
- Tom P Baumgartner
- Bayside Manor Assisted Living LLC
- Staci Brandt
- Colleen Kay Bulau - Overson
- Teresa Ann Burmis
- City of Gaylord
- County of Sibley
All providers in Gaylord, MN · Skilled Nursing Facility in Minnesota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 8, 2021. 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.