NPIMap

Organization Active NPI

Mille Lacs Health System

Doing business as Mille Lacs Home Care

  • Home Health Agency
  • Onamia, MN
National Provider Identifier
1578726311
Registry record updated Mar 21, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
License
339184 Issued in MN
Legal business name
MILLE LACS HEALTH SYSTEM
Doing business as
Mille Lacs Home Care
Practice address
200 Elm St N
Onamia, MN 56359-7901
Phone
(320) 888-4127
Fax
(320) 532-4325
NPI assigned
Jul 2, 2008
Last updated
Mar 21, 2016By the provider in NPPES
Organization subpart
Yes
Parent organization
MILLE LACS HEALTH SYSTEMAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 21, 2016

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

Authorized official

Name
Mr. John W Unzen
Title
Cfo
Phone
(320) 532-2581

Specialties & licenses 8

Specialty (taxonomy)CodeLicenseStatePrimary
Home Health Agency 251E00000X 339184 MN Primary
Social Worker 104100000X NU
Home Health Aide 374U00000X NU
Homemaker 376J00000X NU
Registered Nurse 163W00000X NU
Licensed Practical Nurse 164W00000X NU
Physical Therapist 225100000X NU
Occupational Therapist 225X00000X NU

Addresses

Primary practice location

200 Elm St N
Onamia, MN 56359-7901

Mailing address

200 Elm St N
PO Box a
Onamia, MN 56359-7901
Phone (320) 532-3154

Other identifiers 4

IdentifierTypeStateIssuer
1787ACOOtherMNBLUE CROSS BLUE SHIELD MINNESOTA
190247400MedicaidMN
123281OtherMNUCARE MINNESOTA
5900066OtherMNMEDICA

Other names 1

  • Mille Lacs 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
O20100316000915 MN Part A Provider - Home Health Agency 4789577834 Practice locations: Onamia, MN

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1578726311. Details of each certification follow.

Home health agency certification: CCN 247194

Legal name
MILLE LACS HEALTH SYSTEM
Doing business as
MILLE LACS HOME CARE
Certification status
Active
Provider type (POS)
Home health agency
Participating since
Apr 5, 1985
Last certification
Aug 2, 2018
Ownership / control type
Non-Profit
Organization structure
CorporationNon-profit
Incorporated
Jun 20, 1990 in MN
Enrollment address
200 Elm N St
Onamia, MN 56359-7901

Other NPIs with the same Medicare PAC ID 9

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

Care Compare: Home health agency

Medicare Care Compare
Listed as
Mille Lacs Home CareCCN 247194 · All quality measures
Overall star rating
3.5 of 5
Ownership
Non-Profit
Certified
Apr 5, 1985
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
MLHS Geropsychiatric Unit9 organizations share this tax ID, including this one
Part of
MLHS Geropsychiatric Unit

Other organizations with this tax ID 8

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

Ownership & related parties

All disclosed owners & managing parties 14

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

NameRoleSinceShare
Robert Dubbs Individual Corporate DirectorBoard Member Jan 1, 2017
Rebecca K Fossand Individual Corporate OfficerCao Jan 4, 2016
Amy S Ninham Individual W-2 Managing EmployeeCfo Mar 10, 2025
Elizabeth J Lundquist Individual Corporate DirectorBoard Member Jan 1, 2013
Andrew Knutson Individual Corporate OfficerCeo Jan 27, 2025
W-2 Managing EmployeeCeo Jan 27, 2025
Robert a Athman Individual Corporate DirectorBoard Member Jan 1, 2025
Jean M Stafford Individual Corporate DirectorBoard Member Jan 13, 2022
Roger W Tramm Individual Corporate DirectorBoard Member Jan 1, 2023
Anthony Hass Individual Corporate DirectorBoard Member Jan 1, 2023
Tracy L Sam Individual Corporate DirectorBoard Member Jan 1, 2024
Louis P Gravel Individual Corporate DirectorBoard Member Jan 12, 2012
Patti J Hook Individual Corporate DirectorBoard Member Sep 1, 1991
Arden Virnig Individual W-2 Managing EmployeePhysician Board Member Dec 9, 2009
Dennis Burr Individual Corporate DirectorBoard Member Jan 8, 2015

Owners & managing parties with NPI records 3

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

All facility ownership & control disclosures 4

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Cura of OnamiaOnamia, MN, CCN 245127 Skilled nursing facility Adp of the SNF Jul 22, 2002
Mille Lacs Health SystemOnamia, MN, CCN 241588 Hospice Operational/Managerial Control Jun 17, 2009
Mille Lacs Health SystemIsle, MN, CCN 243975 Rural health clinic Operational/Managerial Control Sep 10, 2008
Mille Lacs Health SystemOnamia, MN, CCN 243976 Rural health clinic Operational/Managerial Control Sep 9, 2008

Owned or controlled facilities with NPI records 4

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

Affiliated clinicians 2

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

NPI Registry JSON

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

{
    "created_epoch": "1214956800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1458518400000",
    "number": "1578726311",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 ELM ST N",
            "address_2": "PO BOX A",
            "city": "ONAMIA",
            "state": "MN",
            "postal_code": "563597901",
            "telephone_number": "320-532-3154",
            "fax_number": "320-532-3111"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 ELM ST N",
            "city": "ONAMIA",
            "state": "MN",
            "postal_code": "563597901",
            "telephone_number": "320-888-4127",
            "fax_number": "320-532-4325"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MILLE LACS HEALTH SYSTEM",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MILLE LACS HEALTH SYSTEM",
        "enumeration_date": "2008-07-02",
        "last_updated": "2016-03-21",
        "status": "A",
        "authorized_official_last_name": "UNZEN",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "320-532-2581",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": "MN",
            "license": "339184",
            "primary": true
        },
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "374U00000X",
            "taxonomy_group": "",
            "desc": "Home Health Aide",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "376J00000X",
            "taxonomy_group": "",
            "desc": "Homemaker",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD MINNESOTA",
            "identifier": "1787ACO",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "190247400",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UCARE MINNESOTA",
            "identifier": "123281",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICA",
            "identifier": "5900066",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mille Lacs Home Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Onamia, MN

Sources for this page

Verify at the official NPI Registry.