NPIMap

Organization Active NPI

Essentia Health Moose Lake

Doing business as Essentia Health Moose Lake Home Care

  • Home Health Agency
  • Moose Lake, MN
National Provider Identifier
1437778529
Registry record updated Feb 27, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
Legal business name
ESSENTIA HEALTH MOOSE LAKE
Doing business as
Essentia Health Moose Lake Home Care
Practice address
30 Arrowhead LN
Moose Lake, MN 55767
Phone
(218) 485-5506
NPI assigned
Apr 9, 2020
Last updated
Feb 27, 2026By the provider in NPPES
Organization subpart
Yes
Parent organization
ESSENTIA HEALTHAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Feb 27, 2026

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

Authorized official

Name
Kevin Boren
Title
VP of Finance
Phone
(218) 786-1009

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X Primary

Addresses

Primary practice location

30 Arrowhead LN
Moose Lake, MN 55767

Mailing address

4572 County Road 61
Moose Lake, MN 55767-9401
Phone (218) 485-4481

Other practice location 1

4614 Mike Colalillo Dr
Duluth, MN 55807-2732
Phone (218) 786-6795

Other names 1

  • ESSENTIA HEALTH MOOSE LAKE HOME CARE Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200728002311 MN Part A Provider - Home Health Agency 6608290333 Practice locations: Duluth, MN; Moose Lake, MN

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1437778529. Details of each certification follow.

Home health agency certification: CCN 248051

Legal name
ESSENTIA HEALTH MOOSE LAKE
Doing business as
ESSENTIA HEALTH MOOSE LAKE HOME CARE
Certification status
Active
Provider type (POS)
Home health agency
Participating since
Jan 23, 1997
Last certification
Feb 28, 2020
Ownership / control type
Non-Profit
Organization structure
CorporationNon-profit
Incorporated
Mar 6, 2020 in MN
Enrollment address
30 Arrowhead LN
Moose Lake, MN 55767
HHA Branch

Other NPIs with the same Medicare PAC ID 2

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

Care Compare: Home health agency

Medicare Care Compare
Listed as
Essentia Health Moose Lake Home CareCCN 248051 · All quality measures
Overall star rating
3 of 5
Ownership
Non-Profit
Certified
Jan 23, 1997
Medicare certification status
ActiveFrom the Provider of Services file
Services
Nursing, Home health aide, Physical therapy, Speech pathology, Occupational therapy

National Provider Directory

National Provider Directory
Tax ID family
Essentia Health Moose Lake2 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.

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

4614 Mike Colalillo Dr
Duluth, MN 55807
Phone (218) 522-0601

4572 County Road 61
Moose Lake, MN 55767
Phone (218) 485-4481

Ownership & related parties

All disclosed owners & managing parties 17

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

NameRoleSinceShare
Krista Ann Skorupa Individual Corporate OfficerPresident May 6, 2024
Amy Bergstrom Individual Corporate Director Jan 1, 2024
Anthony Sertich Individual Corporate DirectorBoard Member Jan 1, 2021
George Loban Individual Corporate Director Jan 1, 2024
Adam Bachand Individual Corporate DirectorBoard Member Jan 1, 2025
Thomas Jamar Individual Corporate DirectorBoard Member Jan 1, 2023
Katharine Finifrock Individual W-2 Managing EmployeeManager Jul 26, 2023
Rebecca Urbanski Individual Corporate DirectorBoard Member Jan 1, 2025
Anthony Yung Individual Corporate DirectorBoard Member Jan 1, 2023
Essentia Health Organization, Duluth, MN Non-profit 5% Or Greater Direct Ownership Interest Jul 1, 2023 100%
Justin Terch Individual Corporate DirectorBoard Member Oct 22, 2025
St Marys Duluth Clinic Health System Organization, Duluth, MN Corporation, Non-profit Operational/Managerial Control Jul 1, 2023
Kevin S Boren Individual Corporate OfficerVP of Finance Oct 1, 2014
W-2 Managing EmployeeVP of Finance Oct 1, 2014
Troy Duininck Individual Corporate DirectorBoard Member Jan 1, 2023
Michael Watters Individual Corporate OfficerSecretary Jul 1, 2023
Bruce Smith Individual Corporate DirectorBoard Member Jan 1, 2026
Nancy Aronson Norr Individual Corporate DirectorBoard Member Jan 1, 2025

Owners & managing parties with NPI records 5

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Facilities with the same owner 46

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

View all 46

Change-of-ownership history 1

DateEventCounterparty
Aug 1, 2020 Change of OwnershipThis provider was the buyer Mercy Home Health AgencyCCN 248051, MN, NPI 1295804482

Change of ownership 1

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

Practitioners & affiliated clinicians

Affiliated clinicians 14

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

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1586390400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1772150400000",
    "number": "1437778529",
    "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"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30 ARROWHEAD LN",
            "city": "MOOSE LAKE",
            "state": "MN",
            "postal_code": "55767",
            "telephone_number": "218-485-5506"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4614 Mike Colalillo Dr",
            "address_purpose": "LOCATION",
            "city": "Duluth",
            "state": "MN",
            "postal_code": "558072732",
            "country_code": "US",
            "telephone_number": "218-786-6795",
            "fax_number": "218-786-6418",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "ESSENTIA HEALTH MOOSE LAKE",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ESSENTIA HEALTH",
        "enumeration_date": "2020-04-09",
        "last_updated": "2026-02-27",
        "certification_date": "2026-02-27",
        "status": "A",
        "authorized_official_last_name": "BOREN",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_title_or_position": "VP OF FINANCE",
        "authorized_official_telephone_number": "218-786-1009"
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ESSENTIA HEALTH MOOSE LAKE HOME CARE",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "ESSENTIA HEALTH MOOSE LAKE HOME CARE",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Moose Lake, MN

Sources for this page

Verify at the official NPI Registry.