NPIMap

Organization Active NPI

Cerenity-Marian of St. Paul, LLC

  • Skilled Nursing Facility
  • Saint Paul, MN
National Provider Identifier
1639689409
Registry record updated May 28, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
CERENITY-MARIAN OF ST. PAUL, LLC
Practice address
200 Earl St
Saint Paul, MN 55106-6714
Phone
(651) 793-2100
Fax
(651) 771-4509
NPI assigned
Oct 6, 2017
Last updated
May 28, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 28, 2021

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

Authorized official

Name
Tricia Bergien
Title
Assistant Treasurer
Phone
(612) 991-6519

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X Primary

Addresses

Primary practice location

200 Earl St
Saint Paul, MN 55106-6714

Mailing address

6499 University Ave NE
Minneapolis, MN 55432-4303

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20171220000494 MN Part A Provider - Skilled Nursing Facility 9335407378 Practice locations: Saint Paul, MN

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1639689409. Details of each certification follow.

Skilled nursing facility certification: CCN 245365B

Legal name
CERENITY-MARIAN OF ST. PAUL, LLC
Organization structure
LLCNon-profit
Incorporated
Sep 14, 2017 in MN
Enrollment address
200 Earl St
Saint Paul, MN 55106-6714
Nursing home name
CERENITY MARIAN OF ST PAUL LLC

National Provider Directory

National Provider Directory

Member of 3

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

Locations

6499 University Ave NE
Minneapolis, MN 55432
Phone (612) 486-2134

200 Earl St
Saint Paul, MN 55106
Phone (651) 771-2914

Ownership & related parties

All disclosed owners & managing parties 12

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

NameRoleSinceShare
Joan Grzywinski Individual Corporate DirectorBoard Member Jun 13, 2014
Kevin J Rymanowski Individual Corporate OfficerTreasurer/Board Member Jul 1, 2005
Tricia Bergien Individual Corporate OfficerAssistant Treasurer Nov 16, 2016
Dawn Marie Ksepka Individual Corporate DirectorBoard Member Jun 13, 2013
Jonathan E Lundberg Individual Corporate DirectorBoard Member Mar 1, 2018
William Foussard Individual Corporate DirectorBoard Member Jun 24, 2010
Cerenity Senior Care Organization, Saint Paul, MN Corporation, Non-profit 5% Or Greater Direct Ownership Interest Dec 15, 2017 100%
Gerald Carley Individual Corporate DirectorBoard Member Jan 2, 2018
Fairview Bethesda Hospital Organization, Saint Paul, MN Non-profit 5% Or Greater Indirect Ownership Interest Dec 15, 2017 50%
Jennifer Bruhn Individual Corporate OfficerPresident Nov 25, 2019
Kay Schumacher Individual Contracted Managing EmployeeAdministrator Jan 15, 2018
Benedictine Health System Organization, Minneapolis, MN Corporation, Management services company, Non-profit 5% Or Greater Indirect Ownership Interest Dec 15, 2017 50%
Operational/Managerial Control Dec 15, 2017 100%

Owners & managing parties with NPI records 2

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

Facilities with the same owner 27

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

View all 27

Practitioners & affiliated clinicians

Practitioners 5

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.

NPI Registry JSON

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

{
    "created_epoch": "1507248000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1622160000000",
    "number": "1639689409",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6499 UNIVERSITY AVE NE",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554324303"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200 EARL ST",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551066714",
            "telephone_number": "651-793-2100",
            "fax_number": "651-771-4509"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CERENITY-MARIAN OF ST. PAUL, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-10-06",
        "last_updated": "2021-05-28",
        "certification_date": "2021-05-28",
        "status": "A",
        "authorized_official_last_name": "BERGIEN",
        "authorized_official_first_name": "TRICIA",
        "authorized_official_title_or_position": "ASSISTANT TREASURER",
        "authorized_official_telephone_number": "612-991-6519"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Paul, MN

Sources for this page

Verify at the official NPI Registry.