NPIMap

Organization Active NPI

PHS Council Bluffs, Inc

  • Skilled Nursing Facility
  • Council Bluffs, IA
National Provider Identifier
1992354666
Registry record updated Nov 11, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
PHS COUNCIL BLUFFS, INC
Practice address
16 Valley View Drive
Council Bluffs, IA 51503
Phone
(651) 631-6450
Fax
(651) 631-6122
NPI assigned
Sep 5, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 11, 2025

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

Authorized official

Name
Mark T Meyer
Title
Cfo
Phone
(651) 631-6102

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X Primary

Addresses

Primary practice location

16 Valley View Drive
Council Bluffs, IA 51503

Mailing address

2845 Hamline Ave N
Roseville, MN 55113-7127
Phone (651) 631-6432

Other names 1

  • Prairie Gate Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200206000236 IA Part A Provider - Skilled Nursing Facility 9133555386 Practice locations: Council Bluffs, IA

Skilled nursing facility certification: CCN 165794

Legal name
PHS COUNCIL BLUFFS INC
Doing business as
PRAIRIE GATE
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Oct 30, 2020
Last certification
Aug 15, 2024
Beds
72
Ownership / control type
Nonprofit Corporation
Multi-facility organization
Presbyterian Homes
Organization structure
CorporationNon-profit
Enrollment address
16 Valley View Dr
Council Bluffs, IA 51503-5104
Nursing home name
PRAIRIE GATE
Affiliated entity
PRESBYTERIAN HOMES & SERVICES

Care Compare: Nursing home

Medicare Care Compare
Listed as
Prairie GateCCN 165794
Overall star rating
2 of 5
Health inspections
2 of 5
Staffing
4 of 5
Quality measures
4 of 5
Type
Medicare and Medicaid
Ownership
Non profit - Corporation
Certified
Oct 30, 2020
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
7234.7 residents per day on average
Chain
Presbyterian Homes & Services21 facilities in the chain
Penalties (3 years)
2Fines totaling $27,630

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
16D2175762Prairie Gate16 Valley View Drive, Council Bluffs, IA 51503Certificate of waiverDec 1, 2027
16D2294022Prairie Gate - SNF16 Valley View Dr, Council Bluffs, IA 51503Certificate of waiverNov 16, 2027

National Provider Directory

National Provider Directory

Ownership & related parties

All disclosed owners & managing parties 9

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

NameRoleSinceShare
Mark T Meyer Individual Operational/Managerial Control Jan 5, 2018
Adp of the SNF Jan 5, 2018
Mark a Pederson Individual Corporate DirectorDirector Jan 1, 2023 33%
Benjamin L Eddy Individual Operational/Managerial Control Oct 1, 2023
Adp of the SNF Oct 1, 2023
Jonathan David Fletcher Individual Corporate OfficerCeo Feb 1, 2025 50%
Corporate DirectorDirector Feb 1, 2025 33%
Operational/Managerial Control Feb 1, 2025
Adp of the SNF Feb 1, 2025
PHS Management, LLC Organization, Roseville, MN LLC, Non-profit, Chain home office Operational/Managerial Control Nov 11, 2019
Adp of the SNF Oct 29, 2025
Heidi a Peterson Individual Corporate DirectorCfo Jan 1, 2023 33%
Operational/Managerial Control Jan 1, 2023
Adp of the SNF Jan 1, 2023
Presbyterian Homes Housing and Assisted Living, Inc. Organization, Saint Paul, MN Corporation, Non-profit Operational/Managerial Control Jan 5, 2018
Eyad Farhan Kakish Individual Operational/Managerial Control Jun 1, 2023
Adp of the SNF Jun 1, 2023
US Bank National Association Organization, Minneapolis, MN Corporation, Financial institution, For-profit 5% Or Greater Mortgage Interest Aug 1, 2018 75%
5% Or Greater Security Interest Aug 1, 2018 75%

Owners & managing parties with NPI records 1

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

Facilities with the same owner 22

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

View all 22

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

Affiliated clinicians 6

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": "1567641600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1762819200000",
    "number": "1992354666",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2845 HAMLINE AVE N",
            "city": "ROSEVILLE",
            "state": "MN",
            "postal_code": "551137127",
            "telephone_number": "651-631-6432",
            "fax_number": "651-631-6122"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16 VALLEY VIEW DRIVE",
            "city": "COUNCIL BLUFFS",
            "state": "IA",
            "postal_code": "51503",
            "telephone_number": "651-631-6450",
            "fax_number": "651-631-6122"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHS COUNCIL BLUFFS, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-09-05",
        "last_updated": "2025-11-11",
        "certification_date": "2025-11-11",
        "status": "A",
        "authorized_official_last_name": "MEYER",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "651-631-6102"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Prairie Gate",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Council Bluffs, IA

Sources for this page

Verify at the official NPI Registry.