Mahnomen Health Center

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

372204 Issued in MN

Legal business name

MAHNOMEN HEALTH CENTER

Practice address

414 W Jefferson Ave
Mahnomen, MN 56557-4912

Phone

(218) 935-2511

Fax

(218) 935-2370

NPI assigned

Jul 11, 2006

Last updated

Aug 31, 2023By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Lori Guenther

Title

Cfo

Phone

(218) 935-9401

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in MN

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1710912787. Details of each certification follow.

• CCN 245238A Skilled nursing facility · Details

Skilled nursing facility certification: CCN 245238A

Legal name

MAHNOMEN HEALTH CENTER

Doing business as

COUNTY OF MAHNOMEN

Organization structure

GovernmentNon-profit

Enrollment address

414 West Jefferson
Mahnomen, MN 56557-4912

Nursing home name

MAHNOMEN HEALTH CENTER

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

• Mahnomen Health Center

  • Rural Acute Care Hospital
  • Mahnomen, MN
  • NPI 1942233234

  3375546112

  Same PAC ID

All disclosed owners & managing parties 4

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

Facilities with the same owner 1

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

• Mahnomen Health Center

  • Rural Acute Care Hospital
  • Mahnomen, MN
  • NPI 1942233234

  City of Mahnomen, Mahnomen County

  CMS ownership

Practitioners 1

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.

• Jon D Larson, MD

  • Family Medicine Physician
  • Detroit Lakes, MN
  • NPI 1508884172
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1152576000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1693440000000",
    "number": "1710912787",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "414 W JEFFERSON AVE",
            "city": "MAHNOMEN",
            "state": "MN",
            "postal_code": "565574912",
            "telephone_number": "218-935-2511",
            "fax_number": "218-935-2370"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "414 W JEFFERSON AVE",
            "city": "MAHNOMEN",
            "state": "MN",
            "postal_code": "565574912",
            "telephone_number": "218-935-2511",
            "fax_number": "218-935-2370"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAHNOMEN HEALTH CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-11",
        "last_updated": "2023-08-31",
        "certification_date": "2023-08-31",
        "status": "A",
        "authorized_official_last_name": "GUENTHER",
        "authorized_official_first_name": "LORI",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "218-935-9401"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "MN",
            "license": "372204",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "739745302",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "0C16NMA",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICA",
            "identifier": "7100426",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Nicole Johnson, NP
• Varya Kelly, OT
• Jessie Marie Kier, DNP, APRN, FNP-BC
• Mahnomen Area Assisted Living Center Inc
• Mahnomen County Human Services
• Mahnomen Health Center
• Mahnomen Isd #432
• Sarah Jean Martinson, RN
• Sharon Mason Shebageget
• David John Mittet, D.C.

• Skilled Nursing Facility in Mahnomen, MN
• Providers in Mahnomen, MN by specialty
• Skilled Nursing Facility in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 31, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.