NPIMap

Organization Active NPI

The North Shore Estates LLC

  • Skilled Nursing Facility
  • Duluth, MN
National Provider Identifier
1548616014
Registry record updated Mar 9, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
THE NORTH SHORE ESTATES LLC
Practice address
7700 Grand Ave
Duluth, MN 55807-2154
Phone
(218) 628-2341
NPI assigned
May 13, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 9, 2017

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

Authorized official

Name
Josh Legum
Title
Member
Phone
(507) 625-8741

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X Primary

Addresses

Primary practice location

7700 Grand Ave
Duluth, MN 55807-2154

Mailing address

638 Southbend Ave
Mankato, MN 56001-2168

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20160520002024 MN Part A Provider - Skilled Nursing Facility 8426347014 Practice locations: Duluth, MN

Skilled nursing facility certification: CCN 245483B

Legal name
THE NORTH SHORE ESTATES LLC
Organization structure
LLCProprietary
Incorporated
Apr 21, 2016 in MN
Enrollment address
7700 Grand Ave
Duluth, MN 55807-2154
Nursing home name
THE NORTH SHORE ESTATES LLC
Affiliated entity
MONARCH HEALTHCARE MANAGEMENT

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
24D0404080North Shore Estates, the7700 Grand Avenue, Duluth, MN 55807Certificate of waiverAug 31, 2026

National Provider Directory

National Provider Directory

Locations

7700 Grand Ave
Duluth, MN 55807
Phone (218) 628-2341

Ownership & related parties

All disclosed owners & managing parties 11

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

NameRoleSinceShare
Jeffrey Muencz Individual 5% Or Greater Indirect Ownership Interest Jul 1, 2016 12%
Spartan Healthcare LLC Organization, Chicago, IL LLC, For-profit 5% Or Greater Direct Ownership Interest Jul 1, 2016 22.5%
William Stern Individual 5% Or Greater Direct Ownership Interest Jul 1, 2016 15%
Corporate OfficerCfo Jul 1, 2016 15%
Marc Halpert Individual 5% Or Greater Indirect Ownership Interest Jul 1, 2016 22.5%
Corporate DirectorChief Operations Officer Jul 1, 2016 22.5%
Jeffrey Arem Individual 5% Or Greater Direct Ownership Interest Jul 1, 2016 14.25%
HML LLC Organization, Beachwood, OH LLC, For-profit 5% Or Greater Direct Ownership Interest Jul 1, 2016 12%
Monarch Healthcare Operating IV LLC Organization, Mankato, MN LLC, Management services company, For-profit Operational/Managerial Control Jul 1, 2016 100%
Joshua Legum Individual 5% Or Greater Indirect Ownership Interest Jul 1, 2016 22.5%
W-2 Managing EmployeeChief Executive Officer Jul 1, 2016 22.5%
Yazoma Holdings, LLC Organization, Skokie, IL LLC, For-profit 5% Or Greater Direct Ownership Interest Jul 1, 2016 22.5%
Noam Jaffa Individual 5% Or Greater Indirect Ownership Interest Jul 1, 2016 13.75%
Nij LLC Organization, St Louis Park, MN LLC, For-profit 5% Or Greater Direct Ownership Interest Jul 1, 2016 13.75%

Facilities with the same owner 44

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

View all 44

Practitioners & affiliated clinicians

Practitioners 4

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

NPI Registry JSON

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

{
    "created_epoch": "1463097600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1489017600000",
    "number": "1548616014",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "638 SOUTHBEND AVE",
            "city": "MANKATO",
            "state": "MN",
            "postal_code": "560012168"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7700 GRAND AVE",
            "city": "DULUTH",
            "state": "MN",
            "postal_code": "558072154",
            "telephone_number": "218-628-2341"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE NORTH SHORE ESTATES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-05-13",
        "last_updated": "2017-03-09",
        "status": "A",
        "authorized_official_last_name": "LEGUM",
        "authorized_official_first_name": "JOSH",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "507-625-8741"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Duluth, MN

Sources for this page

Verify at the official NPI Registry.