Glacial Ridge Hospital District
Organization Active NPI Home Health Agency · Glenwood, MN
NPI 1922017052 · NPPES record last updated Jul 2, 2010
Key facts
- NPI
- 1922017052
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Home Health Agency 251E00000X
- License
- 330414 (MN)
- Legal business name
- GLACIAL RIDGE HOSPITAL DISTRICT
- Practice address
- 10 4TH Ave SE
Glenwood, MN 56334-1820 - Phone
- (320) 634-4521
- Fax
- (320) 634-2262
- NPI assigned
- Aug 7, 2006
- Organization subpart
- No
Authorized official
- Name
- Kirk Stensrud
- Title
- Ceo
- Phone
- (320) 634-2208
Owners & managing parties with NPI records 6
Owned or controlled facilities with NPI records 1
Other NPIs with the same Medicare PAC ID 6
Corporate family (same tax ID) 6
Facilities with the same owner 1
Practitioners 75
-
Elizabeth Ann Ankeny, FNP-C
-
Payton Bausman, MD
-
Sara Ashley Botterill, M.D.
-
Roderick Benjamin Brown, M.D.
-
Erin R Dahlke, M.D.
-
Tanya Freske, CNP
-
Daniel J. Gerwing, PA-C
-
Anne G Gilbertson, CNM
-
Thomas John Haus, M.D.
-
Quinn Jacobs, PA
-
Katelyn Corine Krueger, PA-C
-
Peter John Lindbloom, PA C
-
Gustave L Mellgren, M.D.
-
Mark John Moe, M.D.
-
Jenna Nicole Myrom, FNP
-
Thomas Eric Pahl, PA
-
Alpit D Patel, MBBS
-
Nancy Lynn Pesta Walsh, FNP-BC
-
David Edward Polzin, M.D.
-
Erik C Rivers, PA
-
Jessica Mae Vanderhagen, FNP-C
-
Nicole Marie Zenk, APRN CNP
Affiliated clinicians 5
-
Joshua Luther Eken, M.D.
-
Thomas John Haus, M.D.
-
Quinn Jacobs, PA
-
David Edward Polzin, M.D.
Medicare Care Compare: Home health agency
- Listed as
- Glacial Ridge Home Care
- Overall star rating
- ★★☆☆☆ 2 of 5
- Ownership
- Non-Profit
- Certified
- Nov 14, 1985
- Medicare certification status
- Active
- Services
- Nursing, Home health aide, Physical therapy, Speech pathology, Occupational therapy
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MN
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
- Government · Non-profit
- Incorporated
- Jan 1, 1976 in MN
- Enrollment address
- 219 1St St SE
Glenwood, MN 56334-1603
All disclosed owners & managing parties 4
| Name | Role | Since | Share |
|---|---|---|---|
| Kirk a Stensrud |
Corporate Officer |
Jun 1, 2005 | 100% |
| Operational/Managerial Control |
Jun 1, 2005 | 100% | |
| Glacial Ridge Hospital District |
5% Or Greater Direct Ownership Interest | Mar 19, 2010 | 100% |
| Operational/Managerial Control | Mar 19, 2010 | ||
| Tina Blair |
W-2 Managing Employee | May 1, 2005 | |
| Kyle Chase |
Corporate Officer |
Aug 1, 2010 | 10% |
| W-2 Managing Employee |
Aug 1, 2010 | 10% |
All facility ownership & control disclosures 1
| Facility | Type | Role | Since |
|---|---|---|---|
| Glacial Ridge Hospice |
Hospice | 5% Or Greater Direct Ownership Interest (100%) Operational/Managerial Control |
Mar 4, 1993 Aug 1, 2000 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20100820000615 | MN | Part a Provider - Home Health Agency | 5294789194 | Practice locations: Belgrade, MN; Glenwood, MN |
National Provider Directory
- Tax ID family
- Belgrade Medical Center
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Home Health Agency | 251E00000X | 330414 | MN | Yes |
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 identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 341-547-300 | Medicaid | MN | |
| 1652AGL | Other | MN | BLUE CROSS |
| 5900242 | Other | MEDICA |
Other names
- GLACIAL RIDGE HOMECARE
Other providers in Glenwood, MN
- Glacial Ridge Hospital District
- Glacial Ridge Hospital District
- Glacial Ridge Hospital District
- Glacial Ridge Hospital District
- Glacial Ridge Hospital District
- Glenwood Village Care Center Inc
- Laura R Goraczkowski
- Kari Gritz
- Thomas John Haus
- Brianna Hennen
All providers in Glenwood, MN · Home Health Agency in Minnesota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 2, 2010. 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.