NPIMap

Organization Active NPI

Glencoe Regional Health Services

  • Skilled Nursing Facility
  • Glencoe, MN
National Provider Identifier
1972610079
Registry record updated Sep 13, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
329988 Issued in MN
Legal business name
GLENCOE REGIONAL HEALTH SERVICES
Practice address
1805 Hennepin Ave N
Glencoe, MN 55336-1416
Phone
(320) 864-7790
Fax
(320) 864-7896
NPI assigned
Aug 24, 2006
Last updated
Sep 13, 2018By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 13, 2018

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

Authorized official

Name
John Doidge
Title
VP/Finance
Phone
(320) 864-7753

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X 329988 MN Primary

Addresses

Primary practice location

1805 Hennepin Ave N
Glencoe, MN 55336-1416

Mailing address

1805 Hennepin Ave N
Glencoe, MN 55336-1416
Phone (320) 864-7790

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20080505000752 MN Part A Provider - Skilled Nursing Facility 1759292980 Practice locations: Glencoe, MN

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1972610079. Details of each certification follow.

Skilled nursing facility certification: CCN 245263

Legal name
GLENCOE REGIONAL HEALTH SERVICES
Doing business as
GLENFIELDS LIVING WITH CARE
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Jul 26, 1983
Last certification
Jun 5, 2025
Beds
108
Ownership / control type
Nonprofit Corporation
Organization structure
CorporationNon-profit
Enrollment address
2015 Hennepin Ave N
Glencoe, MN 55336-1446
Nursing home name
GLENFIELDS LIVING WITH CARE

Other NPIs with the same Medicare PAC ID 2

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

Care Compare: Nursing home

Medicare Care Compare
Listed as
Glenfields Living With CareCCN 245263 · All quality measures
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
Non profit - Corporation
Certified
Jul 26, 1983
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
10895.4 residents per day on average

Processed by Care Compare on Aug 1, 2026.

National Provider Directory

National Provider Directory
Tax ID family
Glencoe Regional Health Services4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

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

Member organizations 2

Organizations listed as members of this organization in the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 14

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

NameRoleSinceShare
Angela Erickson Individual Corporate OfficerCfo Feb 9, 2019
W-2 Managing EmployeeCfo Feb 19, 2019
Adp of the SNF Dec 19, 2024
Bryan T Petersen Individual Corporate Director Jul 11, 2011
W-2 Managing EmployeeMD; Jul 11, 2011
Adp of the SNF Dec 19, 2024
Kristine L Knudten Individual Corporate OfficerChief Medical Officer Nov 5, 2018
W-2 Managing EmployeeChief Medical Officer Nov 5, 2018
Benjamin Davis Individual Corporate OfficerPresident & Ceo May 15, 2023
W-2 Managing EmployeePresident & Ceo May 15, 2023
Kristen L Budahn Individual Corporate DirectorPhysician Jan 1, 2024
Jill M Hatlestad Individual W-2 Managing Employee Nov 16, 2007
Heather Peirce Individual Corporate Director Jan 1, 2021
Julie a Schmidt Individual W-2 Managing EmployeeAd; Nov 16, 2007
Adp of the SNF Dec 19, 2024
Sean David Tritabaugh Individual Corporate Director Jan 1, 2024
Scott Kuehn Individual Corporate Director Jan 1, 2017
Mary K Stoltenburg Individual Corporate Director Jan 1, 2018
Lynn Kathryn Beranek Individual W-2 Managing Employee Sep 4, 2023
Bryan J Fritsch Individual Corporate Director Jan 1, 2016
Melea R Anderson Individual W-2 Managing EmployeeChief Nursing Officer Mar 1, 2024

Owners & managing parties with NPI records 4

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

Practitioners & affiliated clinicians

Practitioners 5

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 8

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": "1156377600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1536796800000",
    "number": "1972610079",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1805 HENNEPIN AVE N",
            "city": "GLENCOE",
            "state": "MN",
            "postal_code": "553361416",
            "telephone_number": "320-864-7790",
            "fax_number": "320-864-7896"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1805 HENNEPIN AVE N",
            "city": "GLENCOE",
            "state": "MN",
            "postal_code": "553361416",
            "telephone_number": "320-864-7790",
            "fax_number": "320-864-7896"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GLENCOE REGIONAL HEALTH SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-24",
        "last_updated": "2018-09-13",
        "status": "A",
        "authorized_official_last_name": "DOIDGE",
        "authorized_official_first_name": "JOHN",
        "authorized_official_title_or_position": "VP/FINANCE",
        "authorized_official_telephone_number": "320-864-7753"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "MN",
            "license": "329988",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Glencoe, MN

Sources for this page

Verify at the official NPI Registry.