Warroad Care Center, Inc.
Organization Active NPI Skilled Nursing Facility · Warroad, MN
NPI 1811997489 · NPPES record last updated Feb 20, 2023
Key facts
- NPI
- 1811997489
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Skilled Nursing Facility 314000000X
- Legal business name
- WARROAD CARE CENTER, INC.
- Practice address
- 1401 Lake St NW
Warroad, MN 56763-2026 - Phone
- (218) 386-1235
- Fax
- (218) 386-3548
- NPI assigned
- Jul 26, 2005
- Organization subpart
- No
Authorized official
- Name
- Mark Bertilrud
- Title
- Executive Director
- Phone
- (218) 386-1235
Practitioners 2
Affiliated clinicians 4
-
Shivali Devgon, MD
-
Prasad Munusamy, M.D.
-
Rachel Michele Pearce, DNP FNP-C
Medicare Care Compare: Nursing home
- Listed as
- Warroad Care Center
- Overall star rating
- ★☆☆☆☆ 1 of 5
- Health inspections
- ★☆☆☆☆ 1 of 5
- Staffing
- ★★★★☆ 4 of 5
- Quality measures
- ★★☆☆☆ 2 of 5
- Type
- Medicare and Medicaid
- Ownership
- Non profit - Corporation
- Certified
- Aug 1, 1986
- Medicare certification status
- Active
- Certified beds
- 49 · 46.3 residents per day on average
- Abuse citation
- Cited for abuse (Care Compare abuse icon)
- Penalties (3 years)
- 11 · fines totaling $280,774
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 24D1040163 | Warroad Care Center | Certificate of waiver | May 1, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MN
Skilled nursing facility certification: CCN 245329
- Legal name
- WARROAD CARE CENTER, INC.
- Certification status
- Active
- Provider type (POS)
- Nursing home – SNF/NF dual certification
- Participating since
- Aug 1, 1986
- Last certification
- Nov 6, 2024
- Beds
- 49
- Ownership / control type
- Nonprofit Corporation
- Organization structure
- Corporation · Non-profit
- Incorporated
- Jan 1, 1979 in MN
- Enrollment address
- 1401 Lake St NW
Warroad, MN 56763-2026 - Nursing home name
- WARROAD CARE CENTER
All disclosed owners & managing parties 9
| Name | Role | Since | Share |
|---|---|---|---|
| Maureen Marvin |
Corporate Officer |
Jun 1, 2022 | |
| Tom Casperson |
Corporate Officer |
Jun 1, 2022 | |
| Donnie Ray Musgrove |
Corporate Officer |
Jun 1, 2022 | |
| Ronda Doyle |
Corporate Officer |
Oct 27, 2004 | |
| Deborah J Erickson |
Corporate Officer |
Jan 7, 2010 | |
| Brian Schaible |
Corporate Officer |
Apr 12, 2006 | |
| Robert Evans |
Corporate Officer |
Jun 24, 2009 | |
| Mark Bertilrud |
Corporate Director |
May 9, 2016 | |
| W-2 Managing Employee | May 9, 2016 | ||
| Miki Griffin |
Corporate Officer |
Jun 1, 2022 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040426001204 | MN | Part a Provider - Skilled Nursing Facility | 9739176579 | Practice locations: Warroad, MN |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Skilled Nursing Facility | 314000000X | MN | Yes |
Addresses
Primary practice location
1401 Lake St NW
Warroad, MN 56763-2026
Mailing address
1401 Lake St NW
Warroad, MN 56763-2026
Phone (218) 386-1235
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 974840700 | Medicaid | MN |
Other providers in Warroad, MN
- James R. Thompson
- Thrifty Drug Stores Inc
- Up North Physical Therapy
- Up North Physical Therapy, LLC
- David Alan Verworn
- Warroad Chiropractic Clinic, P.a.
- Warroad Family Dentistry, LTD
- Warroad Heritage Inc
- Warroad School District
All providers in Warroad, MN · Skilled Nursing Facility in Minnesota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 20, 2023. 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.