NPIMap

Organization Active NPI

Lutheran Brethren Retirement Services Inc

Doing business as LB Broen Home

  • Skilled Nursing Facility
  • Fergus Falls, MN
National Provider Identifier
1053307793
Registry record updated Jun 2, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
330241 Issued in MN
Legal business name
LUTHERAN BRETHREN RETIREMENT SERVICES INC
Doing business as
LB Broen Home
Practice address
824 S Sheridan St
Fergus Falls, MN 56537-3022
Phone
(218) 998-7300
Fax
(218) 998-7350
NPI assigned
Sep 27, 2005
Last updated
Jun 2, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 2, 2017

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

Authorized official

Name
Mr. Leland R Rogess
Title
Board Chairman
Phone
(218) 998-7300

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X 330241 MN Primary

Addresses

Primary practice location

824 S Sheridan St
Fergus Falls, MN 56537-3022

Mailing address

824 S Sheridan St
Fergus Falls, MN 56537-3022
Phone (218) 998-7300

Other identifiers 1

IdentifierTypeStateIssuer
678740100MedicaidMN

Other names 1

  • LB Broen Home Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20030422000051 MN Part A Provider - Skilled Nursing Facility 1355250168 Practice locations: Fergus Falls, MN

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1053307793. Details of each certification follow.

Skilled nursing facility certification: CCN 245453

Legal name
LUTHERAN BRETHREN RETIREMENT SERVICES INC
Doing business as
BROEN MEMORIAL HOME
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Apr 1, 1987
Last certification
Aug 28, 2024
Beds
74
Ownership / control type
Nonprofit Corporation
Organization structure
CorporationNon-profit
Incorporated
Oct 13, 1987 in MN
Enrollment address
824 S Sheridan St
Fergus Falls, MN 56537-3022
Nursing home name
LB BROEN HOME

Care Compare: Nursing home

Medicare Care Compare
Listed as
LB Broen HomeCCN 245453 · All quality measures
Overall star rating
2 of 5
Health inspections
2 of 5
Staffing
3 of 5
Quality measures
2 of 5
Type
Medicare and Medicaid
Ownership
Non profit - Corporation
Certified
Apr 1, 1987
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
7455.0 residents per day on average

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
24D0406332LB Broen Home824 South Sheridan Street, Fergus Falls, MN 56537Certificate of waiverAug 31, 2026

National Provider Directory

National Provider Directory
Tax ID family
Lutheran Brethren Retirement Services Inc3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

Ownership & related parties

All disclosed owners & managing parties 10

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

NameRoleSinceShare
Kurt Frustol Individual Corporate OfficerBoard Member Jun 11, 2024
Lutheran Brethren Retirement Services Inc Organization, Fergus Falls, MN Non-profit Operational/Managerial Control Oct 13, 1987
Lisa Jean Vogel Individual Operational/Managerial Control Jun 27, 2022
Adp of the SNF Jun 27, 2022
Andre D Genereux Individual Operational/Managerial Control Oct 1, 2019
Adp of the SNF Jan 16, 2026
Paul Larson Individual Corporate DirectorBoard Member Dec 14, 2017
Tom Moline Individual Corporate DirectorBoard Member Jan 24, 2014
Leland R Rogness Individual Corporate DirectorBoard Chair Apr 22, 2003
Heather J Hickman Individual Corporate DirectorInterim Executive Director Jan 1, 2025 100%
Operational/Managerial Control Jan 1, 2025
Gaylord Folden Individual Corporate DirectorBoard Member Apr 22, 2003
John C Austin Individual Corporate DirectorSecretary/Treasurer Jun 12, 2018

Owners & managing parties with NPI records 1

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

Practitioners & affiliated clinicians

Practitioners 4

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 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": "1127779200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1496361600000",
    "number": "1053307793",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "824 S SHERIDAN ST",
            "city": "FERGUS FALLS",
            "state": "MN",
            "postal_code": "565373022",
            "telephone_number": "218-998-7300",
            "fax_number": "218-998-7350"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "824 S SHERIDAN ST",
            "city": "FERGUS FALLS",
            "state": "MN",
            "postal_code": "565373022",
            "telephone_number": "218-998-7300",
            "fax_number": "218-998-7350"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LUTHERAN BRETHREN RETIREMENT SERVICES INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-09-27",
        "last_updated": "2017-06-02",
        "status": "A",
        "authorized_official_last_name": "ROGESS",
        "authorized_official_first_name": "LELAND",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "BOARD CHAIRMAN",
        "authorized_official_telephone_number": "218-998-7300",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "MN",
            "license": "330241",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "678740100",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "LB Broen Home",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fergus Falls, MN

Sources for this page

Verify at the official NPI Registry.