Mission Farm Nursing Home, Inc

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

331783 Issued in MN

Legal business name

MISSION FARM NURSING HOME, INC

Practice address

3401 E Medicine Lake Blvd
Plymouth, MN 55441-2307

Phone

(763) 559-3123

Fax

(763) 557-9287

NPI assigned

Aug 14, 2006

Last updated

Oct 18, 2011By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Delbert Clark

Title

Administrator

Phone

(763) 559-3123

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MN

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1942213954. Details of each certification follow.

• CCN 245546 Skilled nursing facility · Active · Details

Skilled nursing facility certification: CCN 245546

Legal name

MISSION FARM NURSING HOME, INC

Doing business as

MISSION NURSING HOME

Certification status

Active

Provider type (POS)

Nursing home – SNF/NF dual certification

Participating since

Feb 1, 1991

Last certification

Mar 12, 2025

Beds

70

Ownership / control type

Nonprofit Corporation

Organization structure

CorporationNon-profit

Incorporated

Apr 17, 1975 in MN

Enrollment address

3401 E Medicine Lake Blvd
Plymouth, MN 55441-2307

Nursing home name

MISSION NURSING HOME

Listed as

Mission Nursing HomeCCN 245546 · All quality measures

Overall star rating

1 of 5

Health inspections

2 of 5

Staffing

1 of 5

Quality measures

2 of 5

Type

Medicare and Medicaid

Ownership

Non profit - Corporation

Certified

Feb 1, 1991

Medicare certification status

ActiveFrom the Provider of Services file

Certified beds

7061.8 residents per day on average

Abuse citation

Cited for abuse (Care Compare abuse icon)

Penalties (3 years)

1Fines totaling $14,015

Processed by Care Compare on Aug 1, 2026.

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

CLIA laboratory certificates

All disclosed owners & managing parties 21

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

Owners & managing parties with NPI records 1

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

• Robert G Sonntag, MD

  • Geriatric Medicine (Internal Medicine) Physician
  • Minneapolis, MN
  • NPI 1699741397

  Adp of the SNF, Corporate Director, Operational/Managerial Control

  CMS ownership

Practitioners 2

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.

• Mariam Anwar, MD

  • Geriatric Medicine (Internal Medicine) Physician
  • Coon Rapids, MN
  • NPI 1609044494
  NPD (past)
• Scott J Fairbairn, M.D.

  • Geriatric Medicine (Family Medicine) Physician
  • Minneapolis, MN
  • NPI 1174553747
  NPD (past)

Affiliated clinicians 2

Clinicians who list this facility as an affiliation in Medicare Care Compare.

• Mariam Anwar, MD

  • Geriatric Medicine (Internal Medicine) Physician
  • Coon Rapids, MN
  • NPI 1609044494

  Nursing home

  Care Compare affiliation
• Scott J Fairbairn, M.D.

  • Geriatric Medicine (Family Medicine) Physician
  • Minneapolis, MN
  • NPI 1174553747

  Nursing home

  Care Compare affiliation

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1155513600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1318896000000",
    "number": "1942213954",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3401 E MEDICINE LAKE BLVD",
            "city": "PLYMOUTH",
            "state": "MN",
            "postal_code": "554412307",
            "telephone_number": "763-559-3123",
            "fax_number": "763-557-9287"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3401 E MEDICINE LAKE BLVD",
            "city": "PLYMOUTH",
            "state": "MN",
            "postal_code": "554412307",
            "telephone_number": "763-559-3123",
            "fax_number": "763-557-9287"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MISSION FARM NURSING HOME, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-14",
        "last_updated": "2011-10-18",
        "status": "A",
        "authorized_official_last_name": "CLARK",
        "authorized_official_first_name": "DELBERT",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "763-559-3123",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "MN",
            "license": "331783",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "121742900",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Minnesota Vision Outreach, Inc
• Minnesotawest Home Healthcare Inc
• Minnetonka Pediatric Therapy Center, LLC
• Miracle Ear, Texas Inc.
• Haley Miskowiec, RD
• Missions Inc. Programs (Mission Detox Center)
• Erin Mitchell
• Ian Mitchell
• Mancel Talcott Mitchell III, M.D.
• Mittal Dermatology PA

• Skilled Nursing Facility in Plymouth, MN
• Providers in Plymouth, MN by specialty
• Skilled Nursing Facility in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 18, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.