NPIMap

Organization Active NPI

Regency Home Healthcare Services LLC

  • Home Health Agency
  • Maple Grove, MN
National Provider Identifier
1144260589
Registry record updated May 5, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
License
329047 Issued in MN
Legal business name
REGENCY HOME HEALTHCARE SERVICES LLC
Practice address
10467 93Rd Ave N
Maple Grove, MN 55369-4112
Phone
(651) 488-4655
Fax
(651) 488-4656
NPI assigned
Jun 7, 2006
Last updated
May 5, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 5, 2020

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

Authorized official

Name
Ms. Jean Ann Johnson, RN/RRTNPI 1366085268
Title
Administrator/Owner
Phone
(651) 488-4655

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X 329047 MN Primary
Mental Health Clinic/Center (Including Community Mental Health Center) 261QM0801X

Addresses

Primary practice location

10467 93Rd Ave N
Maple Grove, MN 55369-4112

Mailing address

10467 93Rd Ave N
Maple Grove, MN 55369-4112
Phone (651) 488-4655

Other identifiers 6

IdentifierTypeStateIssuer
59-00256OtherMNMEDICA
3R83REOtherMNBCBS
3R83REOtherMNFIRST PLAN BLUE
96068OtherMNHEALTH PARTNERS
706167600MedicaidMN
164395OtherMNUCARE MINNESOTA

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address gsalzwedel@regenyhhc.com Direct

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031018000000 MN Part A Provider - Home Health Agency 7113839911 Practice locations: Duluth, MN; Austin, MN; Maple Grove, MN

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1144260589. Details of each certification follow.

Home health agency certification: CCN 248081

Legal name
REGENCY HOME HEALTHCARE SERVICES LLC
Certification status
Active
Provider type (POS)
Home health agency
Participating since
May 14, 2004
Last certification
Dec 19, 2019
Ownership / control type
Proprietary
Organization structure
LLCProprietary
Incorporated
May 28, 2003 in MN
Enrollment address
10467 93Rd Ave N
Maple Grove, MN 55369-4112

Care Compare: Home health agency

Medicare Care Compare
Listed as
Regency Home Healthcare Services, LLCCCN 248081 · All quality measures
Overall star rating
1 of 5
Ownership
Proprietary
Certified
May 14, 2004
Medicare certification status
ActiveFrom the Provider of Services file
Services
Nursing, Home health aide, Physical therapy, Occupational therapy

National Provider Directory

National Provider Directory
Tax ID family
Regency Home Healthcare Services3 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.

Locations

611 1st Ave SW
Austin, MN 55912
Phone (507) 434-4900

4961 Rice Lake Rd
Ste 105
Duluth, MN 55803
Phone (218) 727-0296

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.

NameRoleSinceShare
Katelyn Maureen McStott Individual 5% Or Greater Direct Ownership InterestFinance Director Oct 1, 2023 19.5%
Ronald P Johnson Individual 5% Or Greater Direct Ownership Interest Oct 1, 2023 30%
Corporate DirectorPresident Board Chair May 28, 2003 30%
W-2 Managing EmployeePresident Board Chair May 28, 2003 30%
Jean a Johnson Individual 5% Or Greater Direct Ownership Interest Oct 1, 2023 30%
Corporate DirectorPresident/Board Chair Oct 18, 2003 30%
W-2 Managing EmployeePresident Board Chair May 28, 2003 30%
Anthony Jerome Johnson Individual 5% Or Greater Direct Ownership InterestFinance Director Oct 1, 2023 19.5%

Practitioners & affiliated clinicians

Practitioners 18

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.

View all 18

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1149638400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1588636800000",
    "number": "1144260589",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10467 93RD AVE N",
            "city": "MAPLE GROVE",
            "state": "MN",
            "postal_code": "553694112",
            "telephone_number": "651-488-4655",
            "fax_number": "651-488-4656"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10467 93RD AVE N",
            "city": "MAPLE GROVE",
            "state": "MN",
            "postal_code": "553694112",
            "telephone_number": "651-488-4655",
            "fax_number": "651-488-4656"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REGENCY HOME HEALTHCARE SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-07",
        "last_updated": "2020-05-05",
        "certification_date": "2020-05-05",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "JEAN",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "ADMINISTRATOR/OWNER",
        "authorized_official_telephone_number": "651-488-4655",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "RN/RRT"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "MN",
            "license": "329047",
            "primary": true
        },
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICA",
            "identifier": "59-00256",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "3R83RE",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FIRST PLAN BLUE",
            "identifier": "3R83RE",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH PARTNERS",
            "identifier": "96068",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "706167600",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UCARE MINNESOTA",
            "identifier": "164395",
            "state": "MN"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "gsalzwedel@regenyhhc.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "10467 93rd Ave N",
            "city": "Maple Grove",
            "state": "MN",
            "country_code": "US",
            "postal_code": "553694112",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Maple Grove, MN

Sources for this page

Verify at the official NPI Registry.