NPIMap

Organization Active NPI

CCRC of Cedar Rapids, LLC

Doing business as Terrace Glen Village

  • Skilled Nursing Facility
  • Overland Park, KS
National Provider Identifier
1972041952
Registry record updated Aug 2, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
CCRC OF CEDAR RAPIDS, LLC
Doing business as
Terrace Glen Village
Practice address
11827 W 112TH St
Suite 103
Overland Park, KS 66210
Phone
(913) 890-4780
NPI assigned
Feb 9, 2017
Last updated
Aug 2, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 2, 2018

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

Authorized official

Name
Gilbert R Wood
Title
Manager of the LLC
Phone
(913) 599-5705

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X IA Primary

Addresses

Primary practice location

11827 W 112TH St
Suite 103
Overland Park, KS 66210

Mailing address

3400 Alburnett Road
Marion, IA 52302

Other names 1

  • Terrace Glen Village Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20180724002999 IA Part A Provider - Skilled Nursing Facility 3173870094 Practice locations: Marion, IA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1972041952. Details of each certification follow.

Skilled nursing facility certification: CCN 165625

Legal name
CCRC OF CEDAR RAPIDS, LLC
Doing business as
TERRACE GLEN VILLAGE
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Jan 17, 2019
Last certification
Oct 3, 2024
Beds
40
Ownership / control type
Corporation
Multi-facility organization
Pivotal Healthcare
Organization structure
LLCProprietary
Enrollment address
3400 Alburnett Road
Marion, IA 52302-2821
Nursing home name
TERRACE GLEN VILLAGE
Affiliated entity
PIVOTAL HEALTH CARE

Care Compare: Nursing home

Medicare Care Compare
Listed as
Terrace Glen VillageCCN 165625 · All quality measures
Overall star rating
5 of 5
Health inspections
4 of 5
Staffing
5 of 5
Quality measures
5 of 5
Type
Medicare and Medicaid
Ownership
For profit - Corporation
Certified
Jan 17, 2019
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
4038.4 residents per day on average
Chain
Pivotal Health Care9 facilities in the chain

Processed by Care Compare on Aug 1, 2026.

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
16D2147522CCRC of Cedar Rapids, LLC Dba Terrace Glen Village3400 Alburnett Road, Marion, IA 52302Certificate of waiverApr 19, 2028
16D2217892CCRC of Cedar Rapids, LLC3400 Alburnett Road, Marion, IA 52302Certificate of waiverMar 23, 2027

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 31

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

NameRoleSinceShare
Poky Feeders Inc Organization, Scott City, KS Corporation, For-profit, Owned by another organization or individual Indirect Ownership Interest Nov 1, 2018 4.93%
Steven M Howard Individual Indirect Ownership Interest Nov 1, 2018 9.82%
Vincent a Taeger Individual Operational/Managerial Control Nov 1, 2024
Adp of the SNF Nov 1, 2024
Organization, Overland Park, KS LLC, For-profit Adp of the SNF May 15, 2025
Abernathy Family Farms LLC Organization, Cedar Rapids, IA LLC, For-profit, Owned by another organization or individual Direct Ownership Interest Nov 1, 2018 9.87%
Individual Direct Ownership Interest Nov 1, 2018 0.99%
Wayne C Anderson Individual Indirect Ownership Interest Nov 1, 2018 5.41%
Pivotal Health Care LLC Organization, Overland Park, KS LLC, For-profit Operational/Managerial Control Nov 1, 2018 75%
Adp of the SNF May 27, 2025
Individual Direct Ownership Interest Nov 1, 2018 0.99%
Scott E Gulledge Individual Operational/Managerial Control Nov 1, 2018
Adp of the SNF Nov 1, 2018
Indirect Ownership Interest Nov 1, 2018 3.01%
Scenic Holdings LLC Organization, Overland Park, KS LLC, For-profit, Owned by another organization or individual Direct Ownership Interest Jan 1, 2024 61.12%
Mercy Medical Center Organization, Cedar Rapids, IA Non-profit Adp of the SNF Nov 1, 2024
Cadet Investment LLC Organization, Iowa Falls, IA LLC, For-profit, Owned by another organization or individual Indirect Ownership Interest Nov 1, 2018 9.5%
Organization, Muscatine, IA LLC, For-profit Adp of the SNF Nov 12, 2025
Individual Adp of the SNF Nov 1, 2018
5 R Cattle, LLC Organization, Pagosa Springs, CO LLC, For-profit, Owned by another organization or individual Indirect Ownership Interest Nov 1, 2018 4.93%
Marlene a Anderson Individual Indirect Ownership Interest Nov 1, 2018 5.41%
WSG LLC Organization, Overland Park, KS LLC, For-profit, Owned by another organization or individual Indirect Ownership Interest Nov 1, 2018 15.84%
Poky - 5R LLC Organization, Scott City, KS LLC, For-profit, Owned by another organization or individual Indirect Ownership Interest Jan 1, 2024 9.85%
Mouw Family Investments, LLC Organization, Swisher, IA LLC, For-profit, Owned by another organization or individual Direct Ownership Interest Nov 1, 2018 4.93%
Lmray, LLC Organization, Pagosa Springs, CO LLC, For-profit, Owned by another organization or individual Indirect Ownership Interest Nov 1, 2018 4.93%
Gilbert R Wood Individual Operational/Managerial Control Nov 1, 2018
Indirect Ownership Interest Nov 1, 2018 2.15%
Travis S Gulledge Individual Operational/Managerial Control Jan 1, 2025
Adp of the SNF Jan 1, 2025
Indirect Ownership Interest Oct 1, 2021 0.86%
Organization, Oak Brook, IL Non-profit, Owned by another organization or individual Direct Ownership Interest Nov 1, 2018 0.99%
Summit Care, LLC Organization, Overland Park, KS LLC, For-profit Adp of the SNF Nov 1, 2018
3RK, LLC Organization, Pagosa Springs, CO LLC, For-profit, Owned by another organization or individual Indirect Ownership Interest Jan 1, 2024 4.92%
Jordan R Anderson Individual Operational/Managerial Control Jan 1, 2025
Indirect Ownership Interest Oct 1, 2021 7.73%
Scenic Development LLC Organization, Overland Park, KS LLC, For-profit Operational/Managerial Control Nov 1, 2018
Direct Ownership Interest Nov 1, 2018 21.11%
Organization, Overland Park, KS LLC, For-profit Adp of the SNF May 27, 2025
Stephen Tressel Individual Operational/Managerial Control Jun 3, 2019
Adp of the SNF Jun 3, 2019
Organization, Urbandale, IA LLC, For-profit Adp of the SNF May 15, 2025

Owners & managing parties with NPI records 8

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

Facilities with the same owner 9

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners & affiliated clinicians

Practitioners 1

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.

Affiliated clinicians 3

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": "1486598400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1533168000000",
    "number": "1972041952",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3400 ALBURNETT ROAD",
            "city": "MARION",
            "state": "IA",
            "postal_code": "52302"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11827 W 112TH ST",
            "address_2": "SUITE 103",
            "city": "OVERLAND PARK",
            "state": "KS",
            "postal_code": "66210",
            "telephone_number": "913-890-4780"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CCRC OF CEDAR RAPIDS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-02-09",
        "last_updated": "2018-08-02",
        "status": "A",
        "authorized_official_last_name": "WOOD",
        "authorized_official_first_name": "GILBERT",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "MANAGER OF THE LLC",
        "authorized_official_telephone_number": "913-599-5705"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "IA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Terrace Glen Village",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Terrace Glen Village",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Overland Park, KS

Sources for this page

Verify at the official NPI Registry.