NPIMap

Organization Active NPI

Glacial Ridge Hospital District

Doing business as Glacial Ridge Homecare

  • Home Health Agency
  • Glenwood, MN
National Provider Identifier
1922017052
Registry record updated Jul 2, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
License
330414 Issued in MN
Legal business name
GLACIAL RIDGE HOSPITAL DISTRICT
Doing business as
Glacial Ridge Homecare
Practice address
10 4TH Ave SE
Glenwood, MN 56334-1820
Phone
(320) 634-4521
Fax
(320) 634-2262
NPI assigned
Aug 7, 2006
Last updated
Jul 2, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 2, 2010

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

Authorized official

Name
Kirk Stensrud
Title
Ceo
Phone
(320) 634-2208

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X 330414 MN Primary

Addresses

Primary practice location

10 4TH Ave SE
Glenwood, MN 56334-1820

Mailing address

10 4TH Ave SE
Glenwood, MN 56334-1820
Phone (320) 634-4521

Other names 1

  • GLACIAL RIDGE HOMECARE Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100820000615 MN Part A Provider - Home Health Agency 5294789194 Practice locations: Belgrade, MN; Glenwood, MN

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1922017052. Details of each certification follow.

Home health agency certification: CCN 247212

Legal name
GLACIAL RIDGE HOSPITAL DISTRICT
Doing business as
GLACIAL RIDGE HOMECARE
Certification status
Active
Provider type (POS)
Home health agency
Participating since
Nov 14, 1985
Last certification
Jan 4, 2018
Ownership / control type
Non-Profit
Organization structure
GovernmentNon-profit
Incorporated
Jan 1, 1976 in MN
Enrollment address
219 1St St SE
Glenwood, MN 56334-1603

Other NPIs with the same Medicare PAC ID 6

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

Care Compare: Home health agency

Medicare Care Compare
Listed as
Glacial Ridge Home CareCCN 247212 · All quality measures
Overall star rating
2 of 5
Ownership
Non-Profit
Certified
Nov 14, 1985
Medicare certification status
ActiveFrom the Provider of Services file
Services
Nursing, Home health aide, Physical therapy, Speech pathology, Occupational therapy

National Provider Directory

National Provider Directory
Tax ID family
Glacial Ridge Hospital7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

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

Locations

219 1st St SE
Glenwood, MN 56334
Phone (320) 634-2221

Ownership & related parties

All disclosed owners & managing parties 4

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

NameRoleSinceShare
Kirk a Stensrud Individual Corporate OfficerCeo Jun 1, 2005 100%
Operational/Managerial ControlCeo Jun 1, 2005 100%
Glacial Ridge Hospital District Organization, Glenwood, MN 5% Or Greater Direct Ownership Interest Mar 19, 2010 100%
Operational/Managerial Control Mar 19, 2010
Tina Blair Individual W-2 Managing Employee May 1, 2005
Kyle Chase Individual Corporate OfficerCfo Aug 1, 2010 10%
W-2 Managing EmployeeCfo Aug 1, 2010 10%

Owners & managing parties with NPI records 6

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
Glacial Ridge HospiceGlenwood, MN, CCN 241502 Hospice 5% Or Greater Direct Ownership Interest (100%)
Operational/Managerial Control		 Mar 4, 1993
Aug 1, 2000

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

Practitioners 36

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.

View all 36

Affiliated clinicians 5

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": "1154908800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1278028800000",
    "number": "1922017052",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10 4TH AVE SE",
            "city": "GLENWOOD",
            "state": "MN",
            "postal_code": "563341820",
            "telephone_number": "320-634-4521",
            "fax_number": "320-634-2262"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10 4TH AVE SE",
            "city": "GLENWOOD",
            "state": "MN",
            "postal_code": "563341820",
            "telephone_number": "320-634-4521",
            "fax_number": "320-634-2262"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GLACIAL RIDGE HOSPITAL DISTRICT",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-07",
        "last_updated": "2010-07-02",
        "status": "A",
        "authorized_official_last_name": "STENSRUD",
        "authorized_official_first_name": "KIRK",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "320-634-2208"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "MN",
            "license": "330414",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "GLACIAL RIDGE HOMECARE",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Glenwood, MN

Sources for this page

Verify at the official NPI Registry.