Memorial Home, Inc.

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

Legal business name

MEMORIAL HOME, INC.

Practice address

86 22ND Ave
Moundridge, KS 67107-7003

Phone

(620) 345-2901

Fax

(620) 345-2937

NPI assigned

Jul 21, 2005

Last updated

Jul 17, 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

Mr. Jason T Stucky

Title

Ceo

Phone

(620) 345-2901

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in KS

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1801896782. Details of each certification follow.

• CCN 175414 Skilled nursing facility · Active · Details

Skilled nursing facility certification: CCN 175414

Legal name

MEMORIAL HOME, INC.

Doing business as

PINE VILLAGE

Certification status

Active

Provider type (POS)

Nursing home – SNF/NF dual certification

Participating since

Apr 1, 1997

Last certification

May 6, 2025

Beds

99 (74 certified)

Ownership / control type

Nonprofit Corporation

Organization structure

CorporationNon-profit

Enrollment address

86 22ND Ave
Moundridge, KS 67107-7003

Nursing home name

PINE VILLAGE

Listed as

Pine VillageCCN 175414 · All quality measures

Overall star rating

3 of 5

Health inspections

4 of 5

Staffing

4 of 5

Quality measures

1 of 5

Type

Medicare and Medicaid

Ownership

Non profit - Corporation

Certified

Apr 1, 1997

Medicare certification status

ActiveFrom the Provider of Services file

Certified beds

7465.9 residents per day on average

Processed by Care Compare on Aug 1, 2026.

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

CLIA laboratory certificates

All disclosed owners & managing parties 12

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

Practitioners 2

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.

• James D Ratzlaff, M.D.

  • Family Medicine Physician
  • Moundridge, KS
  • NPI 1235134156
  NPD (past)
• Paul D Ullom-Minnich, M.D.

  • Family Medicine Physician
  • Moundridge, KS
  • NPI 1326043241
  NPD (past)

Affiliated clinicians 9

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

• Annie Fast, MD

  • Family Medicine Physician
  • Hesston, KS
  • NPI 1760649693

  Nursing home

  Care Compare affiliation
• Olivia Gehring, MD

  • Family Medicine Physician
  • Moundridge, KS
  • NPI 1013539592

  Nursing home

  Care Compare affiliation
• Jordan Nikole Leatherman, MD

  • Family Medicine Physician
  • Wichita, KS
  • NPI 1417688870

  Nursing home

  Care Compare affiliation
• James D Ratzlaff, M.D.

  • Family Medicine Physician
  • Moundridge, KS
  • NPI 1235134156

  Nursing home

  Care Compare affiliation
• Eyan Roth

  • Family Medicine Physician
  • Hesston, KS
  • NPI 1689241440

  Nursing home

  Care Compare affiliation
• Grace Strella, MD

  • Family Medicine Physician
  • McPherson, KS
  • NPI 1780207217

  Nursing home

  Care Compare affiliation
• Marla R Ullom-Minnich, M.D.

  • Family Medicine Physician
  • Moundridge, KS
  • NPI 1073518999

  Nursing home

  Care Compare affiliation
• Paul D Ullom-Minnich, M.D.

  • Family Medicine Physician
  • Moundridge, KS
  • NPI 1326043241

  Nursing home

  Care Compare affiliation
• Trenton J Vaneaton, MD

  • Family Medicine Physician
  • McPherson, KS
  • NPI 1609831858

  Nursing home

  Care Compare affiliation

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

{
    "created_epoch": "1121904000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1689552000000",
    "number": "1801896782",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "86 22ND AVE",
            "city": "MOUNDRIDGE",
            "state": "KS",
            "postal_code": "671077003",
            "telephone_number": "620-345-2901",
            "fax_number": "620-345-2937"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "86 22ND AVE",
            "city": "MOUNDRIDGE",
            "state": "KS",
            "postal_code": "671077003",
            "telephone_number": "620-345-2901",
            "fax_number": "620-345-2937"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEMORIAL HOME, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-07-21",
        "last_updated": "2023-07-17",
        "certification_date": "2023-07-17",
        "status": "A",
        "authorized_official_last_name": "STUCKY",
        "authorized_official_first_name": "JASON",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "620-345-2901",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100108790",
            "state": "KS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Ken Krehbiel I
• Steve Kuder, PHARMD
• Cara Lapp
• Sharenne G Lohrenz, COTA
• Medical Center Pharmacy Inc. (Moundridge Pharmacy)
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• Anna Grace Miller, OTD
• Moundridge Dental Center Chartered

• Skilled Nursing Facility in Moundridge, KS
• Providers in Moundridge, KS by specialty
• Skilled Nursing Facility in Kansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 17, 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.
• 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.

Verify at the official NPI Registry.