Active NPI
Pelican Valley Health Center
- Skilled Nursing Facility
- Pelican Rapids, MN
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Skilled Nursing Facility
- License
- 331787
- Legal business name
- PELICAN VALLEY HEALTH CENTER
- Practice address
- 211 E Mill Street
Pelican Rapids, MN 56572-0645 - Phone
- (218) 863-2991
- Fax
- (218) 863-5255
- NPI assigned
- Jul 25, 2006
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mr. Richard Kenneth Bratlien
- Title
- Board Chairperson
- Phone
- (218) 842-5106
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Skilled Nursing Facility | 314000000X | 331787 | MN | Primary |
Addresses
Primary practice location
211 E Mill Street
Pelican Rapids, MN 56572-0645
Mailing address
PO Box 645
Pelican Rapids, MN 56572-0645
Phone (218) 863-2911
Other identifiers 5
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 7150033 | Other | MN | MEDICA |
| 30326 | Medicaid | ND | |
| 537342500 | Medicaid | MN | |
| 8979PE | Other | MN | BCBS |
| NH0312 | Other | MN | UCARE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MN
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20120426000652 | MN | Part A Provider - Skilled Nursing Facility | 7911169529 | Practice locations: Pelican Rapids, MN |
NPI to CCN mapping 2
The Medicare certification numbers (CCNs) connected to NPI 1801819636. Details of each certification follow.
Skilled nursing facility certification: CCN 245373
- Legal name
- PELICAN VALLEY HEALTH CENTER
- Certification status
- Active
- Provider type (POS)
- Nursing home – SNF/NF dual certification
- Participating since
- Dec 1, 1986
- Last certification
- Jan 8, 2025
- Beds
- 28
- Ownership / control type
- Hospital District
- Organization structure
- Government
- Incorporated
- Dec 1, 1986 in MN
- Enrollment address
- 211 E Mill Ave
Pelican Rapids, MN 56572-4249 - Nursing home name
- PELICAN VALLEY HEALTH CENTER
- Affiliated entity
- VIVIE
Hospital certification: CCN 240140
Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.
- Legal name
- PELICAN VALLEY HEALTH CENTER
- Certification status
- Terminated Voluntary: merger or closure, Apr 1, 1993
- Provider type (POS)
- Hospital – Short-term
- Participating since
- Apr 1, 1977
- Last certification
- Jan 25, 1991
- Beds
- 13
- Ownership / control type
- Hospital district or authority
- Facility address
- 211 E Mill Street
Pelican Rapids, MN 56572
Care Compare: Nursing home
Medicare Care Compare- Listed as
- Pelican Valley Health Center
- Overall star rating
- Health inspections
- Staffing
- Quality measures
- Type
- Medicare and Medicaid
- Ownership
- Government - Hospital district
- Certified
- Dec 1, 1986
- Medicare certification status
- Active
- Certified beds
- 28
- Chain
- Vivie
National Provider Directory
National Provider Directory- Tax ID family
- Pelican Valley Health C
Other organizations with this tax ID 1
Organizations that report the same tax identification number in the National Provider Directory.
-
- Assisted Living Facility
- Pelican Rapids, MN
- NPI 1730421249
Member of 1
Organizations this organization is a member of, according to the National Provider Directory.
Locations
211 E Mill Ave
Pelican Rapids, MN 56572
Phone (320) 763-1164
Ownership & related parties
All disclosed owners & managing parties 14
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 |
|---|---|---|---|
| Angela Mae Urman | Operational/Managerial Control | Oct 1, 2018 | |
| Richard Kenneth Bratlien | Corporate Officer | Jan 1, 2006 | |
| Susan Bruggeman | Corporate Director | Jan 1, 2007 | |
| Mark Julian Sjostrom | Corporate Officer | Jan 1, 2019 | |
| Tyler Ahlf | Corporate Director | Jun 10, 2019 | |
| W-2 Managing Employee | Jun 10, 2019 | ||
| Patrick Patterson | Corporate Director | Jan 1, 2023 | |
| David Slotten | Corporate Officer | Jan 1, 2017 | |
| Bradley Edwin Knorr | Corporate Director | Jan 1, 2015 | |
| Shannon Erickson | Corporate Director | Jan 1, 2008 | |
| Pelican Valley Health Center | 5% Or Greater Direct Ownership Interest | Oct 1, 2018 | 100% |
| Knute Nelson | Operational/Managerial Control | Oct 1, 2018 | 100% |
| Brian L Evenson | Corporate Officer | Jan 1, 2018 | |
| Mark Robert Anderson | Operational/Managerial Control | Oct 1, 2018 | |
| Marnie Marie Gugisberg | Operational/Managerial Control | Oct 1, 2018 |
Owners & managing parties with NPI records 3
Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.
-
dba Knute Nelson Home Health
- Home Health Agency
- Alexandria, MN
- NPI 1477676229
Operational/Managerial Control
-
dba Knute Nelson Hospice
- Community Based Hospice Care Agency
- Alexandria, MN
- NPI 1548517675
Operational/Managerial Control
-
dba Knute Nelson Care Center
- Skilled Nursing Facility
- Alexandria, MN
- NPI 1689649790
Operational/Managerial Control
Facilities with the same owner 4
Facilities that share an organizational owner with 5% or greater ownership or operational control.
-
dba Heritage Living Center
- Skilled Nursing Facility
- Park Rapids, MN
- NPI 1336182518
Knute Nelson
-
dba Ethos Hospice
- Community Based Hospice Care Agency
- Fargo, ND
- NPI 1598200529
Knute Nelson
Subparts reporting this organization as parent 1
Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.
-
- Assisted Living Facility
- Pelican Rapids, MN
- NPI 1730421249
Practitioners & affiliated clinicians
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.
-
- Family Medicine Physician
- Detroit Lakes, MN
- NPI 1649210832
Affiliated clinicians 2
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": "1153785600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1598054400000",
"number": "1801819636",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 645",
"city": "PELICAN RAPIDS",
"state": "MN",
"postal_code": "565720645",
"telephone_number": "218-863-2911",
"fax_number": "218-863-5255"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "211 E MILL STREET",
"city": "PELICAN RAPIDS",
"state": "MN",
"postal_code": "565720645",
"telephone_number": "218-863-2991",
"fax_number": "218-863-5255"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "PELICAN VALLEY HEALTH CENTER",
"organizational_subpart": "NO",
"enumeration_date": "2006-07-25",
"last_updated": "2020-08-22",
"status": "A",
"authorized_official_last_name": "BRATLIEN",
"authorized_official_first_name": "RICHARD",
"authorized_official_middle_name": "KENNETH",
"authorized_official_title_or_position": "BOARD CHAIRPERSON",
"authorized_official_telephone_number": "218-842-5106",
"authorized_official_name_prefix": "Mr."
},
"taxonomies": [
{
"code": "314000000X",
"taxonomy_group": "",
"desc": "Skilled Nursing Facility",
"state": "MN",
"license": "331787",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICA",
"identifier": "7150033",
"state": "MN"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "30326",
"state": "ND"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "537342500",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "8979PE",
"state": "MN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UCARE",
"identifier": "NH0312",
"state": "MN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Pelican Rapids, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.