Petersburg Medical Center Ltc
P.o. Box 589, Petersburg, AK 99833


Petersburg Medical Center Ltc is nursing home registered in the Centers for Medicare & Medicaid Services (CMS). The Provider Number is 025019. The address is P.o. Box 589, Petersburg, AK 99833. The zip code is 99833. The phone number is 9077724291.


Petersburg Medical Center Ltc · P.o. Box 589, Petersburg, AK 99833

Federal Provider Number 025019
Provider Name PETERSBURG MEDICAL CENTER LTC
Address P.O. BOX 589
PETERSBURG, AK 99833
Phone Number 9077724291
SSA County Code 195
County Name Petersburg Census Area
Ownership Type Government - City/county
Certified Beds 15
Certified Beds Residents 14
Provider Type Medicare and Medicaid
Resides in Hospital true
Legal Business Name THE PETERSBURG MEDICAL CENTER
Date First Approved to Provide Medicare Medicaid Services 01/01/1981
Continuing Care Retirement Community false
Special Focus Facility false
Most Recent Health Inspection More Than 2 Years Ago false
Changed Ownership Last 12 Months false
With Resident Family Council Resident
Automatic Sprinkler Systems in All Required Areas Yes
Overall Rating 5
Health Inspection Rating 4
Quality Measure Rating 5
Staffing Rating 5
RN Staffing Rating 5
Reported CNA Staffing Hours per Resident per Day 3.57143
Reported LPN Staffing Hours per Resident per Day 0.425
Reported RN Staffing Hours per Resident per Day 2.62143
Reported Licensed Staffing Hours per Resident per Day 3.04643
Reported Total Nurse Staffing Hours per Resident per Day 6.61786
Expected CNA Staffing Hours per Resident per Day 2.44767
Expected LPN Staffing Hours per Resident per Day 0.7396
Expected RN Staffing Hours per Resident per Day 1.04621
Expected Total Nurse Staffing Hours per Resident per Day 4.23348
Adjusted CNA Staffing Hours per Resident per Day 3.58023
Adjusted LPN Staffing Hours per Resident per Day 0.47695
Adjusted RN Staffing Hours per Resident per Day 1.87221
Adjusted Total Nurse Staffing Hours per Resident per Day 6.30118
Cycle 1 Total Number of Health Deficiencies 6
Cycle 1 Number of Standard Health Deficiencies 6
Cycle 1 Health Deficiency Score 32
Cycle 1 Standard Survey Health Date 03/17/2017
Cycle 1 Number of Health Revisits 1
Cycle 1 Total Health Score 32
Cycle 2 Total Number of Health Deficiencies 5
Cycle 2 Number of Standard Health Deficiencies 5
Cycle 2 Health Deficiency Score 48
Cycle 2 Standard Health Survey Date 02/19/2016
Cycle 2 Number of Health Revisits 1
Cycle 2 Total Health Score 48
Cycle 3 Total Number of Health Deficiencies 12
Cycle 3 Number of Standard Health Deficiencies 12
Cycle 3 Health Deficiency Score 80
Cycle 3 Standard Health Survey Date 01/22/2015
Cycle 3 Number of Health Revisits 1
Cycle 3 Total Health Score 80
Total Weighted Health Survey Score 45.333
Total Amount of Fines in Dollars $0.00
Processing Date 08/01/2017

Owner or Manager · Petersburg Medical Center Ltc

Owner Name Role Association Date
DORMER, JILL (Individual) OFFICER since 10/01/2013
KOENEMAN, TIMOTHY (Individual) OFFICER since 10/01/2011
KVERNVIK, JANET (Individual) DIRECTOR since 01/01/2010
KVERNVIK, JANET (Individual) MANAGING EMPLOYEE since 01/01/2010
TEJERA, ROCIO (Individual) OFFICER since 01/01/2012
THE PETERSBURG MEDICAL CENTER (Organization) 5% OR GREATER DIRECT OWNERSHIP INTEREST
NO PERCENTAGE PROVIDED
since 11/08/2012
WHITETHORN, DARLENE (Individual) OFFICER since 01/01/2012
WOODYARD, ELIZABETH (Individual) OFFICER since 06/01/2011

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