Active NPI
Dunseith Community Nursing Home
- Skilled Nursing Facility
- Dunseith, ND
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Skilled Nursing Facility
- License
- 1016A
- Legal business name
- DUNSEITH COMMUNITY NURSING HOME
- Practice address
- 15 First St NE
Dunseith, ND 58329 - Phone
- (701) 244-5495
- Fax
- (701) 244-5431
- NPI assigned
- Feb 12, 2007
- Last updated
- Jan 13, 2025
- 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. Justin Lee Decoteau
- Title
- Administrator
- Phone
- (701) 244-5495
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Skilled Nursing Facility | 314000000X | 1016A | ND | Primary |
Addresses
Primary practice location
15 First St NE
Dunseith, ND 58329
Mailing address
Box 669 15 First St NE
Dunseith, ND 58329
Phone (701) 244-5495
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 30052 | Medicaid | ND |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in ND
Enrollment records 2
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20051010000379 | ND | Part A Provider - Skilled Nursing Facility | 3971528993 | Practice locations: Dunseith, ND |
| O20091222000186 | ND | Part B Supplier - Mass Immunization (Roster Biller Only) | 3971528993 | Practice locations: Dunseith, ND |
NPI to CCN mapping 1
The Medicare certification numbers (CCNs) connected to NPI 1811039316. Details of each certification follow.
Skilled nursing facility certification: CCN 355080
- Legal name
- DUNSEITH COMMUNITY NURSING HOME
- Certification status
- Active
- Provider type (POS)
- Nursing home – SNF/NF dual certification
- Participating since
- Nov 1, 1978
- Last certification
- May 2, 2024
- Beds
- 30
- Ownership / control type
- City
- Organization structure
- Other
- Enrollment address
- 15 1St St NE
Dunseith, ND 58329-0669 - Nursing home name
- DUNSEITH COM NURSING HOME
Care Compare: Nursing home
Medicare Care Compare- Listed as
- Dunseith Com Nursing Home
- Overall star rating
- Health inspections
- Staffing
- Quality measures
- Type
- Medicare and Medicaid
- Ownership
- Government - City
- Certified
- Nov 1, 1978
- Medicare certification status
- Active
- Certified beds
- 30
- Abuse citation
- Cited for abuse (Care Compare abuse icon)
- Penalties (3 years)
- 2
Laboratory certificates & supplier records
Derived by NPIMapThese CMS records do not include an NPI. They are shown because their name and street address match this provider’s.
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 35D0408661 | Dunseith Community Nursing Home | Certificate of waiver | Aug 31, 2026 |
National Provider Directory
National Provider DirectoryOwnership & 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.
| Name | Role | Since | Share |
|---|---|---|---|
| Alva Gladue | Managing Control - Governing Body | Nov 29, 2023 | |
| City of Dunseith | 5% Or Greater Direct Ownership Interest | May 6, 1974 | 100% |
| 5% Or Greater Security Interest | May 6, 1974 | 100% | |
| George Gottbreht | Managing Control - Governing Body | Jul 1, 2002 | |
| Justin Lee Decoteau | Operational/Managerial Control | Aug 21, 2021 | |
| Adp of the SNF | Aug 21, 2021 | ||
| Brian L Selland | Operational/Managerial Control | Jan 20, 2014 | |
| Adp of the SNF | May 20, 2025 | ||
| Linda Gunville | Managing Control - Governing Body | Sep 19, 2019 | |
| Janice Azure | Managing Control - Governing Body | Dec 8, 2022 | |
| Chris Strong | Managing Control - Governing Body | Jul 6, 2022 |
Owners & managing parties with NPI records 1
Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.
-
- Family Medicine Physician
- Rugby, ND
- NPI 1710052626
Adp of the SNF, Operational/Managerial Control
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
- Rugby, ND
- NPI 1710052626
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1171238400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1736726400000",
"number": "1811039316",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "BOX 669 15 FIRST ST NE",
"city": "DUNSEITH",
"state": "ND",
"postal_code": "58329",
"telephone_number": "701-244-5495",
"fax_number": "701-244-5431"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "15 FIRST ST NE",
"city": "DUNSEITH",
"state": "ND",
"postal_code": "58329",
"telephone_number": "701-244-5495",
"fax_number": "701-244-5431"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "DUNSEITH COMMUNITY NURSING HOME",
"organizational_subpart": "NO",
"enumeration_date": "2007-02-12",
"last_updated": "2025-01-13",
"certification_date": "2025-01-13",
"status": "A",
"authorized_official_last_name": "DECOTEAU",
"authorized_official_first_name": "JUSTIN",
"authorized_official_middle_name": "LEE",
"authorized_official_title_or_position": "ADMINISTRATOR",
"authorized_official_telephone_number": "701-244-5495",
"authorized_official_name_prefix": "Mr."
},
"taxonomies": [
{
"code": "314000000X",
"taxonomy_group": "",
"desc": "Skilled Nursing Facility",
"state": "ND",
"license": "1016A",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "30052",
"state": "ND"
}
],
"endpoints": [],
"other_names": []
}
Other providers in Dunseith, ND
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 13, 2025; 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.