Lake Valley Hospice LLC

Primary specialty

Community Based Hospice Care AgencyTaxonomy code 251G00000X

Legal business name

LAKE VALLEY HOSPICE LLC

Practice address

4517 Minnetonka Blvd
Suite 105
St. Louis Park, MN 55416-5400

Phone

(612) 900-3667

Fax

(952) 600-8199

NPI assigned

Nov 28, 2022

Organization subpart

No

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

Authorized official

Name

Eran Ratner

Title

Owner

Phone

(516) 668-2204

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MN

Enrollment records 1

Hospice certification: CCN 241619

Legal name

LAKE VALLEY HOSPICE LLC

Certification status

Active

Provider type (POS)

Hospice

Participating since

Dec 21, 2023

Last certification

Dec 7, 2023

Organization structure

LLCProprietary

Enrollment address

4517 Minnetonka Blvd
Ste 105
Saint Louis Park, MN 55416-5400

Listed as

Lake Valley Hospice LLCCCN 241619 · All quality measures

Certified

Dec 21, 2023

Medicare certification status

ActiveFrom the Provider of Services file

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

CLIA laboratory certificates

Locations

All disclosed owners & managing parties 6

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

Owners & managing parties with NPI records 1

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

• Vikas Simon Mittal, MD

  • Internal Medicine Physician
  • Saint Paul, MN
  • NPI 1629038377

  Contracted Managing Employee

  CMS ownership

Practitioners 1

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

• Vikas Simon Mittal, MD

  • Internal Medicine Physician
  • Saint Paul, MN
  • NPI 1629038377
  NPD (past)

Affiliated clinicians 6

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

• Gehad Adel Elfarra, M.D

  • Family Medicine Physician
  • Minneapolis, MN
  • NPI 1063649945

  Hospice

  Care Compare affiliation
• Jeffrey J Herickhoff, MD

  • Family Medicine Physician
  • Saint Paul, MN
  • NPI 1245292424

  Hospice

  Care Compare affiliation
• Kourtny Long, PA-C

  • Physician Assistant
  • Stillwater, MN
  • NPI 1659761898

  Hospice

  Care Compare affiliation
• Vikas Simon Mittal, MD

  • Internal Medicine Physician
  • Saint Paul, MN
  • NPI 1629038377

  Hospice

  Care Compare affiliation
• Heather Christine Pett Taylor, M.D.

  • Family Medicine Physician
  • Stillwater, MN
  • NPI 1467418558

  Hospice

  Care Compare affiliation
• Amber Marie Winkelman, DO

  • Geriatric Medicine (Family Medicine) Physician
  • Minneapolis, MN
  • NPI 1235457763

  Hospice

  Care Compare affiliation

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

{
    "created_epoch": "1669593600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1770854400000",
    "number": "1558071910",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4517 MINNETONKA BLVD",
            "address_2": "SUITE 105",
            "city": "ST. LOUIS PARK",
            "state": "MN",
            "postal_code": "554165400",
            "telephone_number": "612-900-3667",
            "fax_number": "952-600-8199"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4517 MINNETONKA BLVD",
            "address_2": "SUITE 105",
            "city": "ST. LOUIS PARK",
            "state": "MN",
            "postal_code": "554165400",
            "telephone_number": "612-900-3667",
            "fax_number": "952-600-8199"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE VALLEY HOSPICE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-11-28",
        "last_updated": "2026-02-12",
        "certification_date": "2026-02-12",
        "status": "A",
        "authorized_official_last_name": "RATNER",
        "authorized_official_first_name": "ERAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "516-668-2204"
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• William Ladner, M.D.
• Lisa Mary Lafranchi, PA-C
• Nicolas Lafrombois
• Kathryn Elaine Lail, SCHOOL PSYCHOLOGIST
• Wendy Laine, MD
• Melissa Marie Lake, CRNA
• Lakeside Psychology Services, LLC
• Terese A Lalomia, DDS
• Larkin Lalor
• Maria Lanasa

• Community Based Hospice Care Agency in St Louis Park, MN
• Providers in St Louis Park, MN by specialty
• Community Based Hospice Care Agency in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 12, 2026; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.