Moose Lake Community Hospital District

Primary specialty

Home Health AgencyTaxonomy code 251E00000X

License

374783 Issued in MN

Legal business name

MOOSE LAKE COMMUNITY HOSPITAL DISTRICT

Doing business as

Mercy Home Health Agency

Practice address

30 Arrowhead Lane
Moose Lake, MN 55767

Phone

(218) 485-5506

Fax

(218) 485-5908

NPI assigned

Nov 6, 2006

Last updated

Mar 25, 2016By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Michael J Delfs

Title

Chief Executive Officer

Phone

(218) 485-5858

Specialties & licenses 1

Addresses

Other identifiers 3

Other names 1

• Mercy Home Health Agency Doing business as

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Change-of-ownership history 1

Change of ownership 1

Medicare changes of ownership in which this facility was the buyer or the seller.

• Essentia Health Moose Lake

  dba Essentia Health Moose Lake Home Care

  • Home Health Agency
  • Moose Lake, MN
  • NPI 1437778529

  Sold to, 2020-08-01

  CMS change of ownership

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

{
    "created_epoch": "1162771200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1458864000000",
    "number": "1295804482",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4572 COUNTY ROAD 61",
            "city": "MOOSE LAKE",
            "state": "MN",
            "postal_code": "557679401",
            "telephone_number": "218-485-4481",
            "fax_number": "218-485-5845"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30 ARROWHEAD LANE",
            "city": "MOOSE LAKE",
            "state": "MN",
            "postal_code": "55767",
            "telephone_number": "218-485-5506",
            "fax_number": "218-485-5908"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOOSE LAKE COMMUNITY HOSPITAL DISTRICT",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-06",
        "last_updated": "2016-03-25",
        "status": "A",
        "authorized_official_last_name": "DELFS",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "218-485-5858"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "MN",
            "license": "374783",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICA CHOICE",
            "identifier": "5900060",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "1757AME",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "315245600",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mercy Home Health Agency",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Allysan L Mickle, OTR/L
• Minnesota Sex Offender Program
• Brad J Montagne, DC
• Moose Lake Community Hospital District (Mercy Hospital & Health Care Center)
• Moose Lake Community Hospital District (Mercy Hospital & Health Care Center)
• Moose Lake Community Hospital District (Mercy Hospital)
• Moose Lake Eye Care LLC
• Msocs-Moose Lake
• Jacob C Nelson, PHARMD
• Maggie Beth Neudecker, MD

• Home Health Agency in Moose Lake, MN
• Providers in Moose Lake, MN by specialty
• Home Health Agency in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 25, 2016; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.