Active NPI
Moments Hospice of Duluth LLC
Doing business as Moments Hospice
- Community Based Hospice Care Agency
- Hermantown, MN
National Provider Identifier
1114576279
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community Based Hospice Care Agency
- Legal business name
- MOMENTS HOSPICE OF DULUTH LLC
- Doing business as
- Moments Hospice
- Practice address
- 4897 Miller Trunk Hwy Ste 220
Hermantown, MN 55811-1936 - Phone
- (763) 205-3600
- NPI assigned
- Sep 10, 2019
- Last updated
- Sep 21, 2023
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Eliyahu Jaffa
- Title
- President
- Phone
- (715) 800-0908
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Community Based Hospice Care Agency | 251G00000X | NU | Primary |
Addresses
Primary practice location
4897 Miller Trunk Hwy Ste 220
Hermantown, MN 55811-1936
Mailing address
820 Lilac Dr N Ste 210
Golden Valley, MN 55422-4754
Phone (612) 655-5242
Other names 1
- Moments Hospice
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MN
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20191009000717 | MN | Part A Provider - Hospice | 2062743859 | Practice locations: Hermantown, MN |
NPI to CCN mapping 1
The Medicare certification numbers (CCNs) connected to NPI 1114576279. Details of each certification follow.
Hospice certification: CCN 241609
- Legal name
- MOMENTS HOSPICE OF DULUTH LLC
- Doing business as
- MOMENTS HOSPICE
- Certification status
- Active
- Provider type (POS)
- Hospice
- Participating since
- Apr 23, 2020
- Last certification
- Apr 23, 2020
- Ownership / control type
- Proprietary - Other
- Organization structure
- LLC
- Incorporated
- Jun 3, 2019 in MN
- Enrollment address
- 4897 Miller Trunk Hwy
Ste 220
Hermantown, MN 55811-1936
Care Compare: Hospice
Medicare Care Compare- Listed as
- Moments Hospice
- Ownership
- For-Profit
- Certified
- Apr 23, 2020
- Medicare certification status
- Active
National Provider Directory
National Provider DirectoryLocations
4897 Miller Trunk Hwy
Ste 220
Hermantown, MN 55811
Phone (763) 205-3600
Ownership & related parties
All disclosed owners & managing parties 4
As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.
| Name | Role | Since | Share |
|---|---|---|---|
| Shlomo Miller | Corporate Officer | Jun 3, 2019 | 40% |
| Travis Christopher Weber | W-2 Managing Employee | Aug 22, 2024 | |
| Eliyahu Jaffa | 5% Or Greater Direct Ownership Interest | Jun 3, 2019 | 100% |
| Corporate Officer | Jun 3, 2019 | 60% | |
| W-2 Managing Employee | Jun 3, 2019 | 60% | |
| Joseph Greenberg | Contracted Managing Employee | Aug 1, 2025 |
Owners & managing parties with NPI records 1
Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.
-
- Internal Medicine Physician
- St Louis Park, MN
- NPI 1114169356
Contracted Managing Employee
Practitioners & affiliated clinicians
Affiliated clinicians 7
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": "1568073600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1695254400000",
"number": "1114576279",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "820 LILAC DR N STE 210",
"city": "GOLDEN VALLEY",
"state": "MN",
"postal_code": "554224754",
"telephone_number": "612-655-5242"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4897 MILLER TRUNK HWY STE 220",
"city": "HERMANTOWN",
"state": "MN",
"postal_code": "558111936",
"telephone_number": "763-205-3600"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "MOMENTS HOSPICE OF DULUTH LLC",
"organizational_subpart": "NO",
"enumeration_date": "2019-09-10",
"last_updated": "2023-09-21",
"certification_date": "2023-09-21",
"status": "A",
"authorized_official_last_name": "JAFFA",
"authorized_official_first_name": "ELIYAHU",
"authorized_official_title_or_position": "PRESIDENT",
"authorized_official_telephone_number": "715-800-0908"
},
"taxonomies": [
{
"code": "251G00000X",
"taxonomy_group": "",
"desc": "Hospice Care, Community Based",
"state": "NU",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"organization_name": "Moments Hospice",
"code": "3",
"type": "Doing Business As"
},
{
"organization_name": "Moments Hospice",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Hermantown, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 21, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.