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MISSION FARM NURSING HOME, INC
NPI 1942213954
Skilled Nursing Facility in Plymouth, MN

Active since August 14, 2006CLIA 24D0667086 · Waiver
1/5
Overall Rating
3401 E MEDICINE LAKE BLVD, PLYMOUTH, MN 55441(763) 559-3123(763) 557-9287 Get Directions Write a Review

NPPES record last updated: October 18, 2011. Verified against the NPPES registry weekly; last sync: August 16, 2026.

About Mission Farm Nursing Home, Inc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MISSION FARM NURSING HOME, INC (NPI 1942213954) is a healthcare organization registered as a skilled nursing facility in Plymouth, Minnesota and active in the NPI registry since August 2006. The organization holds a CLIA Waiver certificate valid through August 31, 2026 and lists Delbert Clark, Administrator, as its authorized official.

NPPES Registry Identity

NPI1942213954
Entity TypeOrganization
Primary Taxonomy314000000X
Legal Business NameMISSION FARM NURSING HOME, INC
Location Address3401 E MEDICINE LAKE BLVDPlymouth, MN 55441-2307
Mailing Address3401 E Medicine Lake BlvdPlymouth, MN 55441-2307 · (763) 559-3123 · Fax (763) 557-9287
Phone(763) 559-3123
Fax(763) 557-9287
Organization SubpartNo
Authorized OfficialDelbert ClarkAdministrator · (763) 559-3123
Enumeration DateAugust 14, 2006
Last NPPES UpdateOctober 18, 2011
✔ NPI 1942213954 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtySkilled Nursing FacilityNursing & Custodial Care Facilities
Taxonomy Code314000000X
License✔ Licensed in MN · 331783
Definition
(1) A skilled nursing facility is a facility or distinct part of an institution whose primary function is to provide medical, continuous nursing, and other health and social services to patients who are not in an acute phase of illness requiring services in a hospital, but who require primary restorative or skilled nursing services on an inpatient basis above the level of intermediate or custodial care in order to reach a degree of body functioning to permit self care in essential daily living. It meets any licensing or certification standards et forth by the jurisdiction where it is located. A skilled nursing facility may be a freestanding facility or part of a hospital that has been certified by Medicare to admit patients requiring subacute care and rehabilitation; (2) Provides non-acute medical and skilled nursing care services, therapy and social services under the supervision of a licensed registered nurse on a 24-hour basis.
3401 E MEDICINE LAKE BLVD, Plymouth, MN 55441
Open in Google Maps ↗

Other Identifiers 2

Medicare ID-Type Unspecified245546MN · Medicare Provider Number
Medicaid121742900MN

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include HealthPartners.Insurance ›

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 24D0667086

Mission Nursing Home, Inc · Plymouth, MN
Active · expires Aug 31, 2026
CLIA Number24D0667086
Laboratory TypeSkilled Nursing Facility/Nursing Facility
Certificate Effective DateSeptember 1, 2024
Certificate Expiration DateAugust 31, 2026
Laboratory DirectorWill Moncrief
Laboratory Phone(763) 231-5924
Laboratory LocationMission Nursing Home, Inc3401 E Medicine Lake Blvd, Plymouth, MN 55441
CLIA data matches this NPI record on: Address
This certificate is issued to a laboratory to perform only waived tests.

Nursing Home Quality Ratings CMS Care Compare

Quality ratings, staffing and inspection history for Mission Nursing Home (CMS certification number 245546), from CMS Care Compare.

Mission Nursing Home

Nursing home · Plymouth, MN
1/5 CMS Overall Rating
OwnershipNon profit - Corporation
CMS Certification Number245546
Certified Beds65 beds57 residents per day on average
Medicare & Medicaid Participant SinceFebruary 1, 1991
Resident & Family CouncilResident council
Automatic sprinkler system

CMS Star Ratings

Quality Measures
Based on a select set of clinical quality measures.
1/5
Long-Stay Quality
Quality of care delivered to long-term residents.
1/5
Staffing
Based on nursing staff hours relative to resident needs.
3/5
Weighted Health Inspection Score
Lower scores are better; the score summarizes deficiencies found on recent inspections.
62.67
Ratings are assigned by CMS on a one-to-five star scale; five is the highest. Categories without a current CMS rating are not shown.

Staffing & Turnover

Total Nurse Staffing
nurse aide 2.51 · LPN 0.46 · RN 1
3.97 hrs per resident per day
Weekend Nurse Staffing
3.31 hrs per resident per day
Physical Therapist Staffing
0 hrs per resident per day
Higher staffing hours generally allow more direct care time per resident.

Inspections & Enforcement

Facility-Reported Incidents
1
Substantiated Complaints
6
Infection-Control Citations
2
Fines
0
Medicare Payment Denials
0
Total Penalties
0
Counts come from CMS inspections and complaint investigations over approximately the past three years. CMS Care Compare data as of October 1, 2024.

Other Providers at the Same Location NPPES 8

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MR. KADE MELVIN JONES PTA
Physical Therapy Assistant
3401 E MEDICINE LAKE BLVD
PLYMOUTH, MN 55441
Hennepin County (763) 208-5676
KATHLEEN THOMASON OTR/L
Occupational Therapist (Gerontology)
3401 E MEDICINE LAKE BLVD
PLYMOUTH, MN 55441
Hennepin County (763) 559-3123
MS. NOU VANG DPT
Physical Therapist
3401 E MEDICINE LAKE BLVD
PLYMOUTH, MN 55441
Hennepin County (763) 559-3123
KELSEY SPEAKS CF-SLP
Speech-Language Pathologist
3401 E MEDICINE LAKE BLVD
PLYMOUTH, MN 55441
Hennepin County (763) 559-3123
TANYA C USSERY OTA
Occupational Therapy Assistant
3401 E MEDICINE LAKE BLVD
PLYMOUTH, MN 55441
Hennepin County (763) 559-3123
ELIZABETH ANN STIER KOONST M.S. SLP
Speech-Language Pathologist
3401 E MEDICINE LAKE BLVD
PLYMOUTH, MN 55441
Hennepin County (763) 559-3123
MAYAR SAMI ALI COTA
Occupational Therapy Assistant
3401 E MEDICINE LAKE BLVD
PLYMOUTH, MN 55441
Hennepin County (612) 200-7352
MELISSA JO TWIGG
Physical Therapy Assistant
3401 E MEDICINE LAKE BLVD
PLYMOUTH, MN 55441
Hennepin County (763) 559-3123

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Mission Farm Nursing Home, Inc's NPI number?

The NPI number for Mission Farm Nursing Home, Inc is 1942213954. It was assigned to this organization in the NPPES registry on August 14, 2006.

Where is Mission Farm Nursing Home, Inc located?

Mission Farm Nursing Home, Inc is located at 3401 E Medicine Lake Blvd, Plymouth, MN 55441. The listed phone number is (763) 559-3123.

What is Mission Farm Nursing Home, Inc's specialty?

The primary specialty registered for this NPI is Skilled Nursing Facility with taxonomy code 314000000X.

Does Mission Farm Nursing Home, Inc hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 24D0667086) is associated with this NPI, valid through August 31, 2026. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

Is Mission Farm Nursing Home, Inc a Medicare-certified nursing home?

Yes. Mission Nursing Home is a Medicare-certified nursing home with 65 certified beds.

What quality rating does Mission Farm Nursing Home, Inc have?

CMS rates Mission Nursing Home 1 out of 5 stars overall on Care Compare. The full measure detail is in the Nursing Home Quality Ratings section above.

What insurance does Mission Farm Nursing Home, Inc accept?

Health plans from HealthPartners list Mission Farm Nursing Home, Inc as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Mission Farm Nursing Home, Inc was last updated on October 18, 2011. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 14 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.