NPIMap

Organization Active NPI

North Shore Manor, Inc.

Doing business as North Shore Health & Rehab Facility

  • Skilled Nursing Facility
  • Loveland, CO
National Provider Identifier
1790782639
Registry record updated Jul 16, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
0214 Issued in CO
Legal business name
NORTH SHORE MANOR, INC.
Doing business as
North Shore Health & Rehab Facility
Practice address
1365 W 29TH St
Loveland, CO 80538-2561
Phone
(970) 677-6111
Fax
(970) 667-2460
NPI assigned
Jul 7, 2005
Last updated
Jul 16, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 16, 2008

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

Authorized official

Name
Mrs. Deb Prentiss
Title
A/R Manager
Phone
(970) 482-0198

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X 0214 CO Primary

Addresses

Primary practice location

1365 W 29TH St
Loveland, CO 80538-2561

Mailing address

1365 W 29TH St
Loveland, CO 80538-2561
Phone (970) 677-6111

Other identifiers 1

IdentifierTypeStateIssuer
05651294MedicaidCO

Other names 1

  • North Shore Health & Rehab Facility Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100202000910 CO Part A Provider - Skilled Nursing Facility 1456240894 Practice locations: Loveland, CO

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1790782639. Details of each certification follow.

Skilled nursing facility certification: CCN 065129

Legal name
NORTH SHORE MANOR, INC.
Doing business as
NORTH SHORE HEALTH & REHAB FACILITY
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Jul 1, 1975
Last certification
May 16, 2024
Beds
120
Ownership / control type
Limited Liability Corporation
Most recent change of ownership
Feb 4, 2026
Organization structure
OtherProprietary
Incorporated
Mar 6, 1974 in CO
Enrollment address
1365W 29TH St
Loveland, CO 80538-2561

Care Compare: Nursing home

Medicare Care Compare
Listed as
North Shore Health & Rehab FacilityCCN 065129 · All quality measures
Overall star rating
4 of 5
Health inspections
4 of 5
Staffing
3 of 5
Quality measures
4 of 5
Type
Medicare and Medicaid
Ownership
For profit - Limited Liability company
Certified
Jul 1, 1975
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
120104.4 residents per day on average

Processed by Care Compare on Aug 1, 2026.

National Provider Directory

National Provider Directory

Locations

1365 W 29th St
Loveland, CO 80538
Phone (970) 388-3279

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
Jacqueline K King Individual Operational/Managerial ControlNha Jul 1, 2023 100%
John Robert Wilson Individual 5% Or Greater Direct Ownership Interest Aug 19, 1986 15%
Corporate Director Aug 19, 1986 100%
W-2 Managing Employee Aug 19, 1986 100%
Mary E Koretke Individual W-2 Managing EmployeeDirector of Reimbursement Apr 17, 2023
Jay H Moskowitz Individual Contracted Managing EmployeeCeo of QP Health Services LLC Apr 17, 2023 100%
Corporate OfficerCeo QP Healthcare Services Apr 15, 2018 82%
Lauren J Fasciano-Sager Individual Corporate OfficerSecretary Nov 21, 2012
W-2 Managing Employee Nov 21, 2012
QP Health Care Services LLC Organization, Lakewood, CO LLC, Management services company, For-profit Operational/Managerial Control Apr 17, 2023 100%
Barry Kent Fancher Individual Corporate Officer Jul 1, 1999 100%
W-2 Managing Employee Jul 1, 1999 100%
Columbine Management Services Inc Organization, Fort Collins, CO Operational/Managerial Control Dec 1, 1993

Facilities with the same owner 17

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

View all 17

Practitioners & affiliated clinicians

Affiliated clinicians 3

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": "1120694400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1216166400000",
    "number": "1790782639",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1365 W 29TH ST",
            "city": "LOVELAND",
            "state": "CO",
            "postal_code": "805382561",
            "telephone_number": "970-677-6111",
            "fax_number": "970-667-2460"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1365 W 29TH ST",
            "city": "LOVELAND",
            "state": "CO",
            "postal_code": "805382561",
            "telephone_number": "970-677-6111",
            "fax_number": "970-667-2460"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTH SHORE MANOR, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-07-07",
        "last_updated": "2008-07-16",
        "status": "A",
        "authorized_official_last_name": "PRENTISS",
        "authorized_official_first_name": "DEB",
        "authorized_official_title_or_position": "A/R MANAGER",
        "authorized_official_telephone_number": "970-482-0198",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "CO",
            "license": "0214",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "05651294",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "North Shore Health & Rehab Facility",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Loveland, CO

Sources for this page

Verify at the official NPI Registry.