NPIMap

Organization Active NPI

American Baptist Homes of the Midwest

Doing business as Elmcrest Retirement Community

  • Skilled Nursing Facility
  • Harlan, IA
National Provider Identifier
1851389662
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
AMERICAN BAPTIST HOMES OF THE MIDWEST
Doing business as
Elmcrest Retirement Community
Practice address
2104 12TH St
Harlan, IA 51537-2023
Phone
(712) 755-5174
Fax
(712) 755-5654
NPI assigned
Oct 6, 2005
Last updated
Jul 21, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Authorized official

Name
Christina R Kotz
Title
Director of Resident Receivables
Phone
(402) 639-3008

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X IA Primary

Addresses

Primary practice location

2104 12TH St
Harlan, IA 51537-2023

Mailing address

2104 12TH St
Harlan, IA 51537-2023
Phone (712) 755-5174

Other identifiers 1

IdentifierTypeStateIssuer
0800151MedicaidIA

Other names 1

  • Elmcrest Retirement Community Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070606000179 IA Part A Provider - Skilled Nursing Facility 8426966953 Practice locations: Harlan, IA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1851389662. Details of each certification follow.

Skilled nursing facility certification: CCN 165372

Legal name
AMERICAN BAPTIST HOMES OF THE MIDWEST
Doing business as
ELM CREST RETIREMENT COMMUNITY
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Oct 1, 1997
Last certification
Nov 14, 2024
Beds
50
Ownership / control type
Other Nonprofit
Multi-facility organization
American Baptist Homes of the Midwest
Organization structure
CorporationNon-profit
Incorporated
Apr 23, 1987 in MN
Enrollment address
2104 12TH St
Harlan, IA 51537-2023
Nursing home name
ELM CREST RETIREMENT COMMUNITY
Affiliated entity
AMERICAN BAPTIST HOMES OF THE MIDWEST

Other NPIs with the same Medicare PAC ID 3

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Care Compare: Nursing home

Medicare Care Compare
Listed as
Elm Crest Retirement CommunityCCN 165372 · All quality measures
Overall star rating
2 of 5
Health inspections
2 of 5
Staffing
3 of 5
Quality measures
4 of 5
Type
Medicare and Medicaid
Ownership
Non profit - Other
Certified
Oct 1, 1997
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
5045.8 residents per day on average
Chain
American Baptist Homes of the Midwest6 facilities in the chain
Penalties (3 years)
1Fines totaling $0

Processed by Care Compare on Aug 1, 2026.

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
16D0669947Elm Crest Retirement Community2104 12TH Street, Harlan, IA 51537Certificate of waiverAug 31, 2026
16D2194537Elm Crest Retirement Community2104 12TH Street, Harlan, IA 51537Certificate of waiverSep 30, 2026

National Provider Directory

National Provider Directory
Tax ID family
Tudor Oaks Health Cente14 organizations share this tax ID, including this one

Other organizations with this tax ID 13

Organizations that report the same tax identification number in the National Provider Directory.

View all 13

Ownership & related parties

All disclosed owners & managing parties 20

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

NameRoleSinceShare
Ashley Elizabeth Ford Individual Corporate Director Aug 1, 2019
Ruth Ann Neiman Individual Corporate Director Jan 1, 2021
Christina Kotz Individual W-2 Managing Employee Aug 1, 2019
Steven C Vanostram Individual Corporate DirectorBoard Member May 1, 2012
Bruce K Van Der Beek Individual Corporate Director Jan 1, 2021
James Lee Johnson Individual Corporate Director Aug 1, 2019
Roger Allan Davidson Individual Corporate Director Aug 1, 2019
Marshall Peters Individual Corporate DirectorBoard Member May 1, 2012
Melissa Rose Zygarlicke Individual Corporate OfficerTreas/Cfo Aug 1, 2019
Tim Nauslar Individual W-2 Managing EmployeeAdministrator May 1, 2014
Ryan Allen Individual Corporate DirectorBoard Member May 1, 2012
Anne S Wagoner Ford Individual Corporate Director Aug 1, 2019
Dorothy Johnson Individual Corporate Director Aug 1, 2019
Bruce Randolph Whitaker Individual Corporate DirectorBoard Member Jan 1, 2014
Stephanie Nicole Vaughn-Gray Individual Corporate Director Aug 1, 2019
American Baptist Homes of the Midwest Organization, Eden Prairie, MN Non-profit 5% Or Greater Direct Ownership Interest Mar 3, 1967 100%
George Edward Killian Individual Corporate Director Aug 1, 2019
Phillip Hanson Individual Corporate DirectorBoard Member May 1, 2012
Jeffrey J Hongslo Individual Corporate DirectorCeo Nov 1, 2006
Andrea Blatnik Individual Corporate OfficerVP of Human Resources Jul 1, 2013

Owners & managing parties with NPI records 3

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Maple Crest Care CenterOmaha, NE, CCN 285149 Skilled nursing facility 5% Or Greater Direct Ownership Interest (100%) Jan 19, 2010

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Facilities with the same owner 1

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

Practitioners & affiliated clinicians

Affiliated clinicians 7

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": "1128556800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1851389662",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2104 12TH ST",
            "city": "HARLAN",
            "state": "IA",
            "postal_code": "515372023",
            "telephone_number": "712-755-5174",
            "fax_number": "712-755-5654"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2104 12TH ST",
            "city": "HARLAN",
            "state": "IA",
            "postal_code": "515372023",
            "telephone_number": "712-755-5174",
            "fax_number": "712-755-5654"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AMERICAN BAPTIST HOMES OF THE MIDWEST",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-10-06",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "KOTZ",
        "authorized_official_first_name": "CHRISTINA",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "DIRECTOR OF RESIDENT RECEIVABLES",
        "authorized_official_telephone_number": "402-639-3008"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "IA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0800151",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Elmcrest Retirement Community",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Elmcrest Retirement Community",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Harlan, IA

Sources for this page

Verify at the official NPI Registry.