NPIMap

Organization Active NPI

Lifespark Home Health LLC

  • Home Health Agency
  • St Louis Park, MN
National Provider Identifier
1407223282
Registry record updated May 2, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
License
370535 Issued in MN
Legal business name
LIFESPARK HOME HEALTH LLC
Practice address
5320 W 23Rd St Ste 130
St Louis Park, MN 55416-1670
Phone
(952) 345-8770
NPI assigned
Aug 27, 2015
Organization subpart
Yes
Parent organization
LIFESPARK LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on May 2, 2022

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

Authorized official

Name
Brianna Lindeland
Title
Sr Compliance Specialist
Phone
(612) 286-1150

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X 370535 MN Primary

Addresses

Primary practice location

5320 W 23Rd St Ste 130
St Louis Park, MN 55416-1670

Mailing address

5320 W 23Rd St Ste 130
St Louis Park, MN 55416-1670
Phone (952) 345-8770

Other practice location 1

4570 W 77th St
Suite 350
Edina, MN 55435-5008
Phone (952) 345-8770

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20160316001195 MN Part A Provider - Home Health Agency 1254637341 Practice locations: St Louis Park, MN

Home health agency certification: CCN 248118

Legal name
LIFESPARK HOME HEALTH, LLC
Certification status
Active
Provider type (POS)
Home health agency
Participating since
Apr 28, 2011
Last certification
Feb 6, 2020
Ownership / control type
Proprietary
Organization structure
LLCProprietary
Incorporated
Jan 1, 2016 in DE
Enrollment address
5320 W 23Rd St
Ste 130
St Louis Park, MN 55416-1670
HHA Branch

Care Compare: Home health agency

Medicare Care Compare
Listed as
Lifespark Home HealthCCN 248118
Overall star rating
4 of 5
Ownership
Proprietary
Certified
Apr 28, 2011
Medicare certification status
ActiveFrom the Provider of Services file
Services
Nursing, Medical social, Home health aide, Physical therapy, Speech pathology, Occupational therapy

National Provider Directory

National Provider Directory
Tax ID family
Lifespark Home Health2 organizations share this tax ID, including this one
Part of
Agewell Home Care LLC

Other organizations with this tax ID 1

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

Locations

5320 W 23rd St
Ste 130
St Louis Park, MN 55416
Phone (952) 345-3213

Ownership & related parties

All disclosed owners & managing parties 10

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

NameRoleSinceShare
Joel D. Thiesen Revocable Intervivos Trust U/a/D October 6, 2008 Organization, St Louis Park, MN 5% Or Greater Indirect Ownership Interest Aug 6, 2015 34.35%
Virgo Investment Group, LLC Organization, Burlingame, CA LLC, Investment firm 5% Or Greater Indirect Ownership Interest Mar 26, 2020 32.64%
Lifesprk LLC Organization, St Louis Park, MN LLC, For-profit 5% Or Greater Direct Ownership Interest Aug 13, 2021 100%
Solutions Home Care Inc Organization, St Louis Park, MN Corporation 5% Or Greater Indirect Ownership Interest Aug 6, 2015 41.49%
Shannon Podewils Individual Operational/Managerial Control Feb 5, 2026
Joel D Theisen Individual Corporate DirectorBoard Member Aug 6, 2015
Ucare Minnesota Organization, Minneapolis, MN Non-profit 5% Or Greater Indirect Ownership Interest Sep 10, 2021 7.64%
Lifesprk Holdings, Inc. Organization, St Louis Park, MN Created for acquisition, Corporation, Holding company 5% Or Greater Indirect Ownership Interest Mar 26, 2020 100%
Matthew C Kinne Individual Operational/Managerial ControlVice President Aug 6, 2015 45%
Virgo-Vesta LLC Organization, Burlingame, CA LLC 5% Or Greater Indirect Ownership Interest Mar 26, 2020 32.64%

Facilities with the same owner 1

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

  • Lifespark Hospice, LLC
    • Community Based Hospice Care Agency
    • St Louis Park, MN
    • NPI 1295379154

    Joel D. Thiesen Revocable Intervivos Trust U/a/D October 6, 2008, Lifesprk Holdings, Inc., Lifesprk LLC, Solutions Home Care Inc, Ucare Minnesota, Virgo-Vesta LLC

    CMS ownership

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

Affiliated clinicians 85

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 85

NPI Registry JSON

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

{
    "created_epoch": "1440633600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1651449600000",
    "number": "1407223282",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5320 W 23RD ST STE 130",
            "city": "ST LOUIS PARK",
            "state": "MN",
            "postal_code": "554161670",
            "telephone_number": "952-345-8770"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5320 W 23RD ST STE 130",
            "city": "ST LOUIS PARK",
            "state": "MN",
            "postal_code": "554161670",
            "telephone_number": "952-345-8770"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4570 W 77th St",
            "address_2": "Suite 350",
            "address_purpose": "LOCATION",
            "city": "Edina",
            "state": "MN",
            "postal_code": "554355008",
            "country_code": "US",
            "telephone_number": "952-345-8770",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "LIFESPARK HOME HEALTH LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "LIFESPARK LLC",
        "enumeration_date": "2015-08-27",
        "last_updated": "2022-05-02",
        "certification_date": "2022-05-02",
        "status": "A",
        "authorized_official_last_name": "LINDELAND",
        "authorized_official_first_name": "BRIANNA",
        "authorized_official_title_or_position": "SR COMPLIANCE SPECIALIST",
        "authorized_official_telephone_number": "612-286-1150"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "MN",
            "license": "370535",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in St Louis Park, MN

Sources for this page

Verify at the official NPI Registry.