NPIMap

Organization Active NPI

Guardian Angels Elim Home Care, Inc

Doing business as Triniti Home Health and Hospice

  • Community Based Hospice Care Agency
  • Elk River, MN
National Provider Identifier
1174610448
Registry record updated May 20, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Based Hospice Care AgencyTaxonomy code 251G00000X
License
332158 Issued in MN
Legal business name
GUARDIAN ANGELS ELIM HOME CARE, INC
Doing business as
Triniti Home Health and Hospice
Practice address
403 Main St NW
Elk River, MN 55330-1533
Phone
(763) 241-0654
Fax
(763) 241-0274
NPI assigned
Oct 6, 2006
Last updated
May 20, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 20, 2025

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

Authorized official

Name
Ms. Andrea Jung
Title
Ceo
Phone
(763) 241-0654

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Community Based Hospice Care Agency 251G00000X 332158 MN Primary

Addresses

Primary practice location

403 Main St NW
Elk River, MN 55330-1533

Mailing address

403 Main St NW
Elk River, MN 55330-1533
Phone (763) 241-0654

Other identifiers 2

IdentifierTypeStateIssuer
126627600MedicaidMN
3153GUOtherMNBCBS/BLUE PLUS

Other names 1

  • Triniti Home Health and Hospice Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20050831000435 MN Part A Provider - Hospice 4486686300 Practice locations: Buffalo, MN; Cambridge, MN; Elk River, MN

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1174610448. Details of each certification follow.

Hospice certification: CCN 241578

Legal name
GUARDIAN ANGELS ELIM HOME CARE, INC.
Doing business as
TRINITI HOME HEALTH AND HOSPICE
Certification status
Active
Provider type (POS)
Hospice
Participating since
Nov 17, 2005
Last certification
Apr 5, 2018
Ownership / control type
Proprietary - Corporation
Organization structure
CorporationNon-profit
Incorporated
Sep 27, 1996 in MN
Enrollment address
403 Main St NW
Elk River, MN 55330-1533

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Care Compare: Hospice

Medicare Care Compare
Listed as
Triniti HospiceCCN 241578 · All quality measures
Ownership
Non-Profit
Certified
Nov 17, 2005
Medicare certification status
ActiveFrom the Provider of Services file

National Provider Directory

National Provider Directory
Tax ID family
Guardian Angels Elim Home Care Inc2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Locations

403 Main St NW
Elk River, MN 55330
Phone (763) 241-0654

Ownership & related parties

All disclosed owners & managing parties 12

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

NameRoleSinceShare
Troy Hanson Individual Corporate OfficerTreasure Dec 31, 2014
Julie Embry Individual Corporate Director Jan 1, 2016
W-2 Managing EmployeeBusiness Director Jan 1, 2024
Laura Betker Individual W-2 Managing EmployeeHospice Director Jul 1, 2024
Traci Larson Individual Corporate OfficerOfficer Feb 1, 2024
Elim Care Inc Organization, Edina, MN Corporation, Non-profit 5% Or Greater Direct Ownership Interest Sep 27, 1996 50%
Operational/Managerial Control Sep 27, 1996
Guardian Angels of Elk River Inc Organization, Elk River, MN Corporation, Non-profit 5% Or Greater Direct Ownership Interest Sep 27, 1996 50%
Operational/Managerial Control Sep 27, 1996
Megan Otis Individual Contracted Managing EmployeeMedical Director Jan 1, 2023 5%
Krystal Rando Individual Corporate Officer Mar 2, 2026
Andrea J Jung Individual Corporate OfficerPresident Mar 1, 2015
W-2 Managing EmployeeAd;Ceo / President Mar 1, 2014
Kathryn Lee Youngquist Individual Corporate OfficerSecretary Jan 1, 2005
Cynthia Dols Finn Individual Corporate Director Jan 1, 2011
Matthew Ray Kern Individual Corporate Officer Jan 1, 2026

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 12

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

Practitioners & affiliated clinicians

Affiliated clinicians 5

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": "1160092800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1747699200000",
    "number": "1174610448",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "403 MAIN ST NW",
            "city": "ELK RIVER",
            "state": "MN",
            "postal_code": "553301533",
            "telephone_number": "763-241-0654",
            "fax_number": "763-241-0274"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "403 MAIN ST NW",
            "city": "ELK RIVER",
            "state": "MN",
            "postal_code": "553301533",
            "telephone_number": "763-241-0654",
            "fax_number": "763-241-0274"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GUARDIAN ANGELS ELIM HOME CARE, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-06",
        "last_updated": "2025-05-20",
        "certification_date": "2025-05-20",
        "status": "A",
        "authorized_official_last_name": "JUNG",
        "authorized_official_first_name": "ANDREA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "763-241-0654",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": "MN",
            "license": "332158",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "126627600",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS/BLUE PLUS",
            "identifier": "3153GU",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Triniti Home Health and Hospice",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Elk River, MN

Sources for this page

Verify at the official NPI Registry.