Madonna Towers of Rochester, Inc
Organization Active NPI Skilled Nursing Facility · Rochester, MN
NPI 1104821891 · NPPES record last updated May 26, 2022
Key facts
- NPI
- 1104821891
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Skilled Nursing Facility 314000000X
- License
- 328643 (MN)
- Legal business name
- MADONNA TOWERS OF ROCHESTER, INC
- Practice address
- 4001 19TH Ave NW
Rochester, MN 55901-4505 - Phone
- (507) 288-3911
- Fax
- (507) 288-0393
- NPI assigned
- Jun 17, 2005
- Organization subpart
- Yes
- Parent organization (as reported)
- BENEDICTINE HEALTH SYSTEM
Authorized official
- Name
- Tricia L Bergien
- Title
- Director, Reimbursement
- Phone
- (612) 991-6519
Facilities with the same owner 27
Practitioners 2
-
Mairead Mary Bartley, MBBCH
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 24D0955792 | Madonna Towers of Rochester Inc | Certificate of waiver | Jan 10, 2027 |
| 24D1065128 | Madonna Towers | Certificate of waiver | Feb 21, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MN
Skilled nursing facility certification: CCN 245153A
- Legal name
- MADONNA TOWERS OF ROCHESTER, INC
- Doing business as
- MADONNA TOWERS OF ROCHESTER
- Organization structure
- Corporation · Non-profit
- Incorporated
- May 8, 1995 in MN
- Enrollment address
- 4001 19TH Ave NW
Rochester, MN 55901-4505 - Nursing home name
- MADONNA TOWERS OF ROCHESTER
- Affiliated entity
- BENEDICTINE HEALTH SYSTEM
All disclosed owners & managing parties 17
| Name | Role | Since | Share |
|---|---|---|---|
| Barbara Trueman |
Corporate Director |
Sep 1, 2018 | |
| Barbara Graham |
Corporate Director |
Aug 31, 2018 | |
| Bruce Snyder |
Corporate Director |
Sep 1, 2014 | |
| Kevin J Rymanowski |
Corporate Officer |
Jan 1, 2008 | |
| Diane Eustice |
Corporate Director |
Sep 1, 2014 | |
| Tricia Bergien |
Corporate Officer |
Jan 1, 2017 | |
| Justin R Anderson |
Corporate Director |
Sep 1, 2012 | |
| Christine K Boldt |
Corporate Director |
Sep 1, 2005 | |
| Michael Obrien |
Corporate Director |
Nov 1, 2012 | |
| James Russell |
Corporate Director |
Feb 18, 2016 | |
| Gerald Carley |
Operational/Managerial Control |
Jan 3, 2018 | |
| Larry Koshire |
Corporate Director |
May 21, 2015 | |
| Timothy Geisler |
Corporate Director |
Jan 1, 2013 | |
| Michael Willard |
Corporate Director |
Sep 1, 2014 | |
| Christine Marie Bakke |
Contracted Managing Employee |
Apr 17, 2017 | |
| Diane J Schwinghammer |
Corporate Director |
Sep 1, 2013 | |
| Benedictine Health System |
5% Or Greater Direct Ownership Interest | May 25, 1995 | 100% |
| Operational/Managerial Control | May 25, 1995 | 100% |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040419001246 | MN | Part a Provider - Skilled Nursing Facility | 6305831231 | Practice locations: Rochester, MN |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Skilled Nursing Facility | 314000000X | 328643 | MN | Yes |
Addresses
Primary practice location
4001 19TH Ave NW
Rochester, MN 55901-4505
Mailing address
4001 19TH Ave NW
Rochester, MN 55901-4505
Phone (507) 288-3911
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 931216100 | Medicaid | MN |
Other names
- Madonna Towers of Rochester
Other providers in Rochester, MN
- Avanish Madhavaram
- Nicolas N Madigan
- Theresa Madigan
- Princess Madison
- Madonna Meadows
- Karla Madrigal
- Annetta Madeline Madsen
- Bo E Madsen
- Jack G Madsen
- Heidi Madson
All providers in Rochester, MN · Skilled Nursing Facility in Minnesota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 26, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.