Organization Active NPI

St. Marks Lutheran Home

Doing business as Kenwood Heritage Living

  • Skilled Nursing Facility
  • Austin, MN
National Provider Identifier
1093776395
Registry record updated Oct 3, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
328526 Issued in MN
Legal business name
ST. MARKS LUTHERAN HOME
Doing business as
Kenwood Heritage Living
Practice address
400 15TH Ave SW
Austin, MN 55912-3232
Phone
(507) 437-4594
Fax
(507) 434-7201
NPI assigned
Mar 28, 2006
Last updated
Oct 3, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 3, 2025

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

Authorized official

Name
Paula Kay Rocheleau
Title
Authorized Agent
Phone
(320) 302-0192

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Assisted Living Facility 310400000X 329304 MN
Skilled Nursing Facility 314000000X 328526 MN Primary

Addresses

Primary practice location

400 15TH Ave SW
Austin, MN 55912-3232

Mailing address

400 15TH Ave SW
Austin, MN 55912-3232
Phone (507) 437-4594

Other identifiers 1

IdentifierTypeStateIssuer
055842700MedicaidMN

Other names 1

  • Kenwood Heritage Living Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040520001306 MN Part A Provider - Skilled Nursing Facility 7810988573 Practice locations: Austin, MN

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1093776395. Details of each certification follow.

Skilled nursing facility certification: CCN 245369

Legal name
ST MARKS LUTHERAN HOME
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Dec 1, 1986
Last certification
Apr 3, 2025
Beds
45
Ownership / control type
Nonprofit Corporation
Organization structure
CorporationNon-profit
Incorporated
Aug 13, 1958 in MN
Enrollment address
400 15TH Ave SW
Austin, MN 55912-3232
Nursing home name
ST MARKS LIVING

Care Compare: Nursing home

Medicare Care Compare
Listed as
St Marks LivingCCN 245369 · All quality measures
Overall star rating
1 of 5
Health inspections
1 of 5
Staffing
4 of 5
Quality measures
2 of 5
Type
Medicare and Medicaid
Ownership
Non profit - Corporation
Certified
Dec 1, 1986
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
4535.1 residents per day on average
Penalties (3 years)
3Fines totaling $127,000

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
24D0884163St Marks Lutheran Home400 15TH Ave SW, Austin, MN 55912Certificate of waiverMar 25, 2028

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

400 15th Ave SW
Austin, MN 55912
Phone (507) 437-4594

Ownership & related parties

All disclosed owners & managing parties 16

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

NameRoleSinceShare
Craig Gary Ritter Individual Operational/Managerial Control Jun 1, 2024
Adp of the SNF Jun 1, 2024
Paula K Rocheleau Individual Operational/Managerial Control Jun 1, 2024
Adp of the SNF Jun 1, 2024
Emily Brandenburg Individual Managing Control - Governing Body Nov 1, 2025
John Jr. Gray Individual Managing Control - Governing BodyVice President Jun 1, 2024
Connie Simonson Individual Managing Control - Governing BodyDirector Jun 1, 2021
Gayle Gullickson Individual Managing Control - Governing BodyDirector Jun 1, 2024
James Braaten Individual Managing Control - Governing BodyBoard Member Mar 18, 2019
Megan Alvarado Individual Operational/Managerial Control Nov 11, 2024
Adp of the SNF Nov 11, 2024
Jennifer Marie Langbehn Individual Operational/Managerial Control Jun 1, 2024
Adp of the SNF Jun 1, 2024
Crystal Ellefson Individual Operational/Managerial Control Jun 1, 2024
Adp of the SNF Jun 1, 2024
Nancy Donahue Individual Managing Control - Governing BodySecretary Jun 1, 2021
Duane Dahlback Individual Managing Control - Governing BodyDirector Jun 1, 2024
Kimberly M Rocheleau Individual Operational/Managerial Control Jun 1, 2024
Adp of the SNF Jun 1, 2024
Partners Senior Living Options LLC Organization, Royalton, MN LLC, Management services company, For-profit Operational/Managerial Control Jun 1, 2024
Harlan Nelson Individual Corporate DirectorVice President Jun 1, 2024 10%
Managing Control - Governing BodyVice President Jun 1, 2024
Bradley R Johnson Individual Corporate OfficerBoard President Mar 17, 2008
Managing Control - Governing BodyPresident Mar 17, 2008

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 4

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

Practitioners & affiliated clinicians

Practitioners 1

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 1

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": "1143504000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1759449600000",
    "number": "1093776395",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 15TH AVE SW",
            "city": "AUSTIN",
            "state": "MN",
            "postal_code": "559123232",
            "telephone_number": "507-437-4594",
            "fax_number": "507-434-7201"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 15TH AVE SW",
            "city": "AUSTIN",
            "state": "MN",
            "postal_code": "559123232",
            "telephone_number": "507-437-4594",
            "fax_number": "507-434-7201"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST. MARKS LUTHERAN HOME",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-03-28",
        "last_updated": "2025-10-03",
        "certification_date": "2025-10-03",
        "status": "A",
        "authorized_official_last_name": "ROCHELEAU",
        "authorized_official_first_name": "PAULA",
        "authorized_official_middle_name": "KAY",
        "authorized_official_title_or_position": "AUTHORIZED AGENT",
        "authorized_official_telephone_number": "320-302-0192"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "MN",
            "license": "329304",
            "primary": false
        },
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "MN",
            "license": "328526",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "055842700",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Kenwood Heritage Living",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Kenwood Heritage Living",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Austin, MN

Sources for this page

Verify at the official NPI Registry.