Ausable Valley Continuing Care Retirement Community, Inc.
Organization Active NPI Skilled Nursing Facility · Fairview, MI
NPI 1730177015 · NPPES record last updated Sep 24, 2024
Key facts
- NPI
- 1730177015
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Skilled Nursing Facility 314000000X
- Legal business name
- AUSABLE VALLEY CONTINUING CARE RETIREMENT COMMUNITY, INC.
- Practice address
- 1390 Maple Dr
Fairview, MI 48621-8703 - Phone
- (989) 848-2241
- Fax
- (989) 848-5526
- NPI assigned
- Oct 11, 2005
- Organization subpart
- No
Authorized official
- Name
- Timothy Robert Kalbfleisch
- Title
- Cfo
- Phone
- (248) 635-3316
Owners & managing parties with NPI records 3
-
David Dennis Dargis, D.O.
Member of 1
Facilities with the same owner 2
Practitioners 2
-
David Dennis Dargis, D.O.
-
John Wilkins, DO
Medicare Care Compare: Nursing home
- Listed as
- Wellspring Lutheran Services
- Overall star rating
- ★★★★☆ 4 of 5
- Health inspections
- ★★★★☆ 4 of 5
- Staffing
- ★★★★☆ 4 of 5
- Quality measures
- ★★★★☆ 4 of 5
- Type
- Medicare and Medicaid
- Ownership
- For profit - Corporation
- Certified
- Apr 18, 1979
- Medicare certification status
- Active
- Certified beds
- 39 · 36.4 residents per day on average
- Penalties (3 years)
- 1 · fines totaling $0
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 23D0650820 | Wellspring Lutheran Services | Certificate of waiver | Aug 31, 2026 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MI
Skilled nursing facility certification: CCN 235400
- Legal name
- AUSABLE VALLEY CONTINUING CARE RETIREMENT COMMUNITY INC
- Doing business as
- WELLSPRING LUTHERAN SERVICES
- Certification status
- Active
- Provider type (POS)
- Nursing home – SNF/NF dual certification
- Participating since
- Apr 18, 1979
- Last certification
- Jul 10, 2024
- Beds
- 39
- Ownership / control type
- Corporation
- Multi-facility organization
- Wellspring Lutheran Services
- Organization structure
- Corporation · Non-profit
- Incorporated
- Aug 3, 1979 in MI
- Enrollment address
- 1390 Maple Dr
Fairview, MI 48621-8703 - Nursing home name
- WELLSPRING LUTHERAN SERVICES
All disclosed owners & managing parties 11
| Name | Role | Since | Share |
|---|---|---|---|
| Paul F Nyquist |
Corporate Director |
Jan 27, 2014 | |
| David M Gehm |
Corporate Officer |
Jan 1, 2011 | |
| Operational/Managerial Control | Jan 1, 2011 | ||
| Adp of the SNF | Nov 14, 2011 | ||
| Peter Bender |
Corporate Director |
Jun 1, 2012 | |
| Timothy Robert Kalbfleisch |
Corporate Officer |
Sep 1, 2019 | |
| Adp of the SNF | Sep 1, 2019 | ||
| Andrea Logan |
Corporate Director |
Jun 18, 2012 | |
| Carl H Schoenow |
Corporate Director |
Nov 24, 2014 | |
| David Dargis |
Operational/Managerial Control | Jan 1, 2020 | |
| Adp of the SNF | Jan 1, 2020 | ||
| Ritch Randall Cushway |
Corporate Director |
May 9, 2013 | |
| Fawn Naffien |
Operational/Managerial Control | May 1, 2022 | |
| Adp of the SNF | May 1, 2022 | ||
| Amy Sue Benko |
Corporate Director |
Apr 4, 2016 | |
| Lutheran Homes of Michigan, Inc |
5% Or Greater Direct Ownership Interest | Jan 1, 2011 | 100% |
| Adp of the SNF | Jan 1, 2011 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20090911000273 | MI | Part a Provider - Skilled Nursing Facility | 6608921846 | Practice locations: Fairview, MI |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nursing Facility/Intermediate Care Facility | 313M00000X | MI | ||
| Skilled Nursing Facility | 314000000X | MI | Yes |
Addresses
Primary practice location
1390 Maple Dr
Fairview, MI 48621-8703
Mailing address
1390 Maple Dr
Fairview, MI 48621-8703
Phone (989) 848-2241
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2152404 | Medicaid | MI |
Other names
- Wellspring Lutheran Services
Other providers in Fairview, MI
- Susan Lynn Allred
- Alexis Atwell
- Michele Lee Billmaier
- Troy Brown
- Alora Ehlert
- Angela Lynne Enos
- Fairview Chiropractic PLLC
All providers in Fairview, MI · Skilled Nursing Facility in Michigan
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 24, 2024. 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.