North Ridge Skilled, LLC
Organization Active NPI Skilled Nursing Facility · New Hope, MN
NPI 1881689628 · NPPES record last updated Oct 17, 2019
Key facts
- NPI
- 1881689628
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Skilled Nursing Facility 314000000X
- License
- 327788 (MN)
- Legal business name
- NORTH RIDGE SKILLED, LLC
- Practice address
- 5430 Boone Ave N
New Hope, MN 55428-3615 - Phone
- (763) 492-3000
- NPI assigned
- Sep 19, 2005
- Organization subpart
- No
Authorized official
- Name
- Barnes Michelle
- Title
- Director Revenue Cycle Management
- Phone
- (813) 895-1797
Owners & managing parties with NPI records 1
-
Clemencia Rasquinha, M.D
Facilities with the same owner 38
Practitioners 10
-
Scott J Fairbairn, M.D.
-
Brian Lewis, MD
-
Luis A Martinez, M.D.
-
Susan K Nelson, MD
-
Thanh Tam N Nguyen, M.D.
-
Miriam V Ragab, DO
-
Clemencia Rasquinha, M.D
-
Subhadra Chereddy, MBBS
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 24D0402687 | North Ridge Health and Rehab | Certificate of waiver | Aug 31, 2026 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MN
Skilled nursing facility certification: CCN 245183A
- Legal name
- NORTH RIDGE SKILLED, LLC
- Doing business as
- NORTH RIDGE HEALTH AND REHAB
- Organization structure
- LLC · Proprietary
- Incorporated
- Nov 15, 2013 in FL
- Enrollment address
- 5430 Boone Ave North
New Hope, MN 55428-3615 - Nursing home name
- NORTH RIDGE HEALTH AND REHAB
- Affiliated entity
- MISSION HEALTH COMMUNITIES
All disclosed owners & managing parties 14
| Name | Role | Since | Share |
|---|---|---|---|
| Stuart D Lindeman |
5% Or Greater Indirect Ownership Interest | Jan 1, 2014 | 5% |
| North Ridge Operator LLC |
5% Or Greater Direct Ownership Interest | Jan 1, 2014 | 100% |
| Jamie Yoakum |
Corporate Officer |
Mar 20, 2024 | |
| Operational/Managerial Control |
Mar 20, 2024 | ||
| Michelle Barnes |
Operational/Managerial Control |
Dec 1, 2018 | |
| Barres, LLC |
5% Or Greater Indirect Ownership Interest | Jan 1, 2014 | 5% |
| Joseph M Passero |
5% Or Greater Indirect Ownership Interest | Jan 1, 2014 | 5% |
| Clemencia Rasquinha |
Corporate Director |
Apr 2, 2024 | |
| Scott N Feuer |
5% Or Greater Indirect Ownership Interest | Jan 1, 2014 | 45% |
| T and C Capital Assets, LLC |
5% Or Greater Indirect Ownership Interest | Jan 1, 2014 | 5% |
| Bryan L Crino |
5% Or Greater Indirect Ownership Interest | Jan 1, 2014 | 45% |
| Mission Health Communities |
Operational/Managerial Control | Jan 1, 2014 | 100% |
| Mission Health Communities, LLC |
Operational/Managerial Control | Jan 1, 2014 | |
| Windward Health Partners LLC |
5% Or Greater Indirect Ownership Interest | Jan 1, 2014 | 90% |
| David K McCray |
Corporate Director |
Apr 2, 2024 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20131223000000 | MN | Part a Provider - Skilled Nursing Facility | 8022245901 | Practice locations: New Hope, MN |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Assisted Living Facility | 310400000X | MN | ||
| Skilled Nursing Facility | 314000000X | 327788 | MN | Yes |
Addresses
Primary practice location
5430 Boone Ave N
New Hope, MN 55428-3615
Mailing address
5430 Boone Ave N
New Hope, MN 55428-3615
Phone (763) 592-2600
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 531716900 | Medicaid | MN | |
| 530698100 | Medicaid | MN |
Other names
- North Ridge Health and Rehab
Other providers in New Hope, MN
- Larry Nguyen
- Nicollet Family Dentistry
- Farah Ahamed Noorani
- North Ridge Adult Day Care LLC
- North Ridge Skilled LLC
- Julie Nowariak
- Nujchi LLC
- Nurses Health Care LLC
- Nurses Health Care LLC
- Rashmi Samantha O'Hara
All providers in New Hope, 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 Oct 17, 2019. 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.