Community Nursing Home Inc – Skilled Nursing Facility

Key facts

NPI: 1952307472
Entity type: Organization (NPI type 2)
Primary specialty: Skilled Nursing Facility 314000000X
License: 120205 (IA)
Legal business name: COMMUNITY NURSING HOME INC
Practice address: 115 N Hilton
Clarksville, IA 50619-7936
Phone: (319) 278-4900
Fax: (319) 278-4166
NPI assigned: Jun 21, 2005
Organization subpart: No

Authorized official

Name: Henry J Mennenga
Title: Vice President
Phone: (319) 278-4900

Owners & managing parties with NPI records 3

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

Blue Stone Therapy Inc. Physical Medicine & Rehabilitation Physician · Urbandale, IA · NPI 1932797297

CMS ownership ADP OF THE SNF
Lee O Fagre, MD Family Medicine Physician · Waverly, IA · NPI 1982649018

CMS ownership ADP OF THE SNF · OPERATIONAL/MANAGERIAL CONTROL
Ryka Incorporated Community/Retail Pharmacy · Waverly, IA · NPI 1194876581

CMS ownership ADP OF THE SNF

Corporate family (same tax ID) 1

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

Community Nursing Home Inc Custodial Care Facility · Clarksville, IA · NPI 1265516801

NPD tax ID

Affiliated clinicians 4

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

Jodi Bangasser, ARNP Primary Care Nurse Practitioner · Charles City, IA · NPI 1023465267

Care Compare affiliation Nursing home
Julie Marie Cousin, NP Family Nurse Practitioner · Waverly, IA · NPI 1598238347

Care Compare affiliation Nursing home
Lee O Fagre, MD Family Medicine Physician · Waverly, IA · NPI 1982649018

Care Compare affiliation Nursing home
Kaitlin Hilmer, ARNP, FNP-C Family Nurse Practitioner · Waverly, IA · NPI 1033924600

Care Compare affiliation Nursing home

Medicare Care Compare: Nursing home

Listed as: Clarksville Skilled Nursing & Rehab Center CCN 165495
Overall star rating: ★★★★☆ 4 of 5
Health inspections: ★★★★☆ 4 of 5
Staffing: ★★★★☆ 4 of 5
Quality measures: ★★☆☆☆ 2 of 5
Type: Medicare and Medicaid
Ownership: For profit - Corporation
Certified: Apr 1, 2004
Medicare certification status: Active (Provider of Services file)
Certified beds: 42 · 34.8 residents per day on average

Source: Medicare Care Compare, processed Aug 1, 2026.

Laboratory certificates & supplier records

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

CLIA laboratory certificates

CLIA number	Laboratory	Certificate	Expires
16D0384572	Clarksville Skilled Nursing & Rehabilitation Ctr 115 North Hilton, PO Box 159, Clarksville, IA 50619	Certificate of waiver	Aug 31, 2026

Medicare participation

Medicare fee-for-service enrollment: Enrolled in IA

Skilled nursing facility certification: CCN 165495

Legal name: COMMUNITY NURSING HOME INC
Doing business as: CLARKSVILLE SKILLED NURSING AND REHABILITATION CENTER
Certification status: Active
Provider type (POS): Nursing home – SNF/NF dual certification
Participating since: Apr 1, 2004
Last certification: Apr 3, 2025
Beds: 42
Ownership / control type: Corporation
Organization structure: Corporation · Proprietary
Enrollment address: 115 N Hilton St
Clarksville, IA 50619-7936
Nursing home name: CLARKSVILLE SKILLED NURSING & REHAB CENTER

All disclosed owners & managing parties 59

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

Name	Role	Since	Share
Individual	Adp of the SNF	Oct 1, 2024
Individual	Adp of the SNF	Oct 1, 2024
Individual	Adp of the SNF	Jan 1, 2021
Individual	Adp of the SNF	Oct 1, 2024
Dean Martin Individual	5% Or Greater Direct Ownership Interest Owner	Jul 21, 2011	6.48%
Ryka Incorporated Organization · Waverly, IA Corporation, Consulting firm	Adp of the SNF	Dec 31, 2020
Cedar Valley Nutrition Consulting LLC Organization · Cedar Falls, IA LLC, Consulting firm	Adp of the SNF	Jan 1, 2021
Heather M Sells Individual	Operational/Managerial Control	Nov 4, 2013
Heather M Sells Individual	Adp of the SNF	Mar 3, 2026
Individual	Adp of the SNF	Oct 1, 2024
Individual	Adp of the SNF	Oct 1, 2024
Individual	Adp of the SNF	Dec 31, 2020
Individual	Adp of the SNF	Nov 22, 2022
Blue Stone Therapy Inc Organization · Urbandale, IA Corporation	Adp of the SNF	Jan 1, 2024
Individual	Adp of the SNF	Oct 1, 2024
Janice L Metz Individual	Corporate Officer Secretry	Apr 28, 2009
Individual	Adp of the SNF	Oct 1, 2024
Robert Wyatt Individual	Corporate Officer Treasurer	Mar 1, 2021
Individual	Adp of the SNF	Oct 1, 2024
Individual	Adp of the SNF	Jan 1, 2021
Individual	Adp of the SNF	Nov 22, 2022
Individual	Adp of the SNF	Oct 1, 2024
Individual	Adp of the SNF	Oct 1, 2024
Individual	Adp of the SNF	Oct 1, 2024
Jonathan Myers Individual	Operational/Managerial Control	Dec 15, 2008
Individual	Adp of the SNF	Oct 1, 2024
Carney Alexander Marold & Co LLP Organization · Waterloo, IA Consulting firm	Adp of the SNF	May 31, 2021
Individual	Adp of the SNF	Oct 1, 2024
Individual	Adp of the SNF	Jan 31, 2021
Cattail Inc Organization · Muscatine, IA Corporation	Adp of the SNF	Oct 1, 2024
Calvin Mennenga Individual	Corporate Officer Vice President	Apr 11, 2024
Rebecca Cramer Individual	Operational/Managerial Control	Apr 22, 2013
Iowa Health Care Association Organization · West Des Moines, IA Corporation	Adp of the SNF	Oct 1, 2024
Individual	Adp of the SNF	May 31, 2021
Tamela Mayer Individual	Operational/Managerial Control	Jun 1, 2023
Individual	Adp of the SNF	Dec 31, 2020
Jane Arenholz Individual	Corporate Director	Apr 11, 2025
Individual	Adp of the SNF	Oct 1, 2024
Susan Lodge Individual	Corporate Director Director	Apr 21, 2016	11%
Individual	Adp of the SNF	Oct 1, 2024
Ecsi Inc Organization · West Des Moines, IA Corporation	Adp of the SNF	Oct 1, 2024
Chris Backer Individual	Corporate Director Director	Apr 1, 2018	11%
Individual	Adp of the SNF	Oct 1, 2024
Steven L Arenholz Individual	Corporate Officer President	Apr 1, 2018	11%
Steven L Arenholz Individual	Corporate Director Director	Apr 1, 2018	11%
Cattail Consulting LLC Organization · Muscatine, IA LLC, Consulting firm	Adp of the SNF	Sep 30, 2022
Individual	Adp of the SNF	Oct 1, 2024
Individual	Adp of the SNF	Oct 1, 2024
Dale Amunson Individual	Corporate Director Director	Nov 17, 2021
Jordan Pierce Individual	Operational/Managerial Control	Feb 28, 2023
Individual	Adp of the SNF	Oct 1, 2024
Lee O Fagre Individual	Operational/Managerial Control	Jul 1, 2016
Lee O Fagre Individual	Adp of the SNF	Feb 25, 2026
Individual	Adp of the SNF	Oct 1, 2024
Individual	Adp of the SNF	Oct 1, 2024
Brandi Derfield Individual	Operational/Managerial Control	Mar 1, 2023
Jeffery Kolb Individual	Corporate Director Director	Nov 17, 2021
Cattail BCG LLC Organization · Muscatine, IA LLC	Adp of the SNF	Oct 1, 2024
Individual	Adp of the SNF	Oct 1, 2024
Individual	Adp of the SNF	Oct 1, 2024
Finn Enterprises, Inc. Organization · Clear Lake, IA Corporation, Consulting firm	Adp of the SNF	Jan 31, 2021
Brighton Consulting Group LLC Organization · Urbandale, IA LLC, Consulting firm	Adp of the SNF	Oct 1, 2024

Medicare enrollment records

Enrollment ID	State	Provider type	PAC ID	Details
O20040209001260	IA	Part a Provider - Skilled Nursing Facility	2365336633	Practice locations: Clarksville, IA

National Provider Directory

Tax ID family: Clarksville Skilled Nursing Rehab Ctr (2 organizations share this tax ID)

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Skilled Nursing Facility	314000000X	120205	IA	Yes
Home Delivered Meals	332U00000X	120205	IA
Respite Care	385H00000X	120205	IA

Addresses

Primary practice location

115 N Hilton
Clarksville, IA 50619-7936

Mailing address

115 N Hilton
Clarksville, IA 50619-7936
Phone (319) 278-4900

Other identifiers

Identifier	Type	State	Issuer
0800821	Medicaid	IA
0790030	Medicaid	IA

Other names

Community Nursing Home Doing business as

Other providers in Clarksville, IA

All providers in Clarksville, IA · Skilled Nursing Facility in Iowa

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 18, 2012. 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.

Verify at the official NPI Registry.