Lexington Square LLC – Skilled Nursing Facility

Key facts

NPI: 1790772341
Entity type: Organization (NPI type 2)
Primary specialty: Skilled Nursing Facility 314000000X
Legal business name: LEXINGTON SQUARE LLC
Practice address: 500 Messenger Road
Keokuk, IA 52632-2117
Phone: (319) 524-5321
NPI assigned: Sep 29, 2005
Organization subpart: No

Authorized official

Name: Susan Grant
Title: Administrator
Phone: (319) 524-5321

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Halley C Anderson, DO Geriatric Medicine (Family Medicine) Physician · Quincy, IL · NPI 1427495803

CMS ownership ADP OF THE SNF · MANAGING CONTROL - GOVERNING BODY

Facilities with the same owner 1

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

Dave'S Place LLC Mental Illness Intermediate Care Facility · Keokuk, IA · NPI 1366740268

CMS ownership LEXINGTON SQUARE IRREVOCABLE TRUST

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

Halley C Anderson, DO Geriatric Medicine (Family Medicine) Physician · Quincy, IL · NPI 1427495803

NPD (past)

Affiliated clinicians 1

Clinicians who list this facility as an affiliation in Medicare Care Compare.

Halley C Anderson, DO Geriatric Medicine (Family Medicine) Physician · Quincy, IL · NPI 1427495803

Care Compare affiliation Nursing home

Medicare Care Compare: Nursing home

Listed as: Mississippi Valley CCN 165151
Overall star rating: ★★★☆☆ 3 of 5
Health inspections: ★★★☆☆ 3 of 5
Staffing: ★★★☆☆ 3 of 5
Quality measures: ★★☆☆☆ 2 of 5
Type: Medicare and Medicaid
Ownership: For profit - Limited Liability company
Certified: Mar 25, 1989
Medicare certification status: Active (Provider of Services file)
Certified beds: 83 · 57.2 residents per day on average
Penalties (3 years): 2 · fines totaling $19,663

Source: Medicare Care Compare, processed Aug 1, 2026.

Laboratory certificates & supplier records

Name & address match These CMS records do not include an NPI. They are shown here because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA number	Laboratory	Certificate	Expires
16D0387456	Mississippi Valley 500 Messenger Road, Keokuk, IA 52632	Certificate of waiver	Aug 31, 2026

Medicare participation

Medicare fee-for-service enrollment: Enrolled in IA

Skilled nursing facility certification: CCN 165151

Legal name: LEXINGTON SQUARE LLC
Doing business as: MISSISSIPPI VALLEY HEALTHCARE & REHABILITATION CENTER
Certification status: Active
Provider type (POS): Nursing home – SNF/NF dual certification
Participating since: Mar 25, 1989
Last certification: Apr 3, 2025
Beds: 83
Ownership / control type: Limited Liability Corporation
Organization structure: LLC · Proprietary
Enrollment address: 500 Messenger Rd
Keokuk, IA 52632-2117
Nursing home name: MISSISSIPPI VALLEY

All disclosed owners & managing parties 9

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

Name	Role	Since	Share
Michael Blume Individual	Operational/Managerial Control	Apr 1, 2023
	Managing Control - Governing Body Administrator	Jan 20, 2016
	Adp of the SNF	Aug 20, 2024
Lexington Square Irrevocable Trust Organization · Fort Dodge, IA	Operational/Managerial Control	Apr 7, 2017
	Direct Ownership Interest	Apr 7, 2017	100%
David Israel Individual	Managing Control - Governing Body Trustee	Aug 12, 2025
Murray Stanley Individual	Operational/Managerial Control	Apr 1, 2017
	Managing Control - Governing Body Trustee	Apr 7, 2022
	Trustee of the SNF	Apr 1, 2017
	Adp of the SNF	Apr 1, 2017
Bell Bank Arrowhead Office Organization · Peoria, AZ Financial institution	5% Or Greater Mortgage Interest	Jun 15, 2022	66%
Paige Peterson Individual	Managing Control - Governing Body Trustee	Apr 7, 2022
Paige Peterson Individual	Trustee of the SNF	Apr 6, 2022
Halley C Anderson Individual	Managing Control - Governing Body Medical Diretor	Oct 18, 2023
Halley C Anderson Individual	Adp of the SNF	Apr 17, 2025
Heather Hoskins Individual	Operational/Managerial Control	Mar 20, 2024
Heather Hoskins Individual	Managing Control - Governing Body Office Manager	Mar 15, 2011
Terri Abell Individual	Operational/Managerial Control	Mar 3, 2022
Terri Abell Individual	Managing Control - Governing Body Risk Manager	Jan 20, 2016

Medicare enrollment records

Enrollment ID	State	Provider type	PAC ID	Details
O20031218000899	IA	Part a Provider - Skilled Nursing Facility	4385541002	Practice locations: Keokuk, IA

National Provider Directory

Locations

500 Messenger Rd
Keokuk, IA 52632
Phone (319) 524-5321

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Skilled Nursing Facility	314000000X			Yes

Addresses

Primary practice location

500 Messenger Road
Keokuk, IA 52632-2117

Mailing address

500 Messenger Road
Keokuk, IA 52632-2117
Phone (319) 524-5321

Other identifiers

Identifier	Type	State	Issuer
0809624	Medicaid	IA

Other providers in Keokuk, IA

All providers in Keokuk, IA · Skilled Nursing Facility in Iowa

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 14, 2011. 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.

Verify at the official NPI Registry.