Cerenity-Marian of St. Paul, LLC
Organization Active NPI Skilled Nursing Facility · Saint Paul, MN
NPI 1639689409 · NPPES record last updated May 28, 2021
Key facts
- NPI
- 1639689409
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Skilled Nursing Facility 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
- Organization subpart
- No
Authorized official
- Name
- Tricia Bergien
- Title
- Assistant Treasurer
- Phone
- (612) 991-6519
Owners & managing parties with NPI records 2
Member of 3
Facilities with the same owner 27
Practitioners 5
-
Janet L Bijwadia, M.D.
-
Gehad Adel Elfarra, M.D
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MN
Skilled nursing facility certification: CCN 245365B
- Legal name
- CERENITY-MARIAN OF ST. PAUL, LLC
- Organization structure
- LLC · Non-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
All disclosed owners & managing parties 12
| Name | Role | Since | Share |
|---|---|---|---|
| Joan Grzywinski |
Corporate Director |
Jun 13, 2014 | |
| Kevin J Rymanowski |
Corporate Officer |
Jul 1, 2005 | |
| Tricia Bergien |
Corporate Officer |
Nov 16, 2016 | |
| Dawn Marie Ksepka |
Corporate Director |
Jun 13, 2013 | |
| Jonathan E Lundberg |
Corporate Director |
Mar 1, 2018 | |
| William Foussard |
Corporate Director |
Jun 24, 2010 | |
| Cerenity Senior Care |
5% Or Greater Direct Ownership Interest | Dec 15, 2017 | 100% |
| Gerald Carley |
Corporate Director |
Jan 2, 2018 | |
| Fairview Bethesda Hospital |
5% Or Greater Indirect Ownership Interest | Dec 15, 2017 | 50% |
| Jennifer Bruhn |
Corporate Officer |
Nov 25, 2019 | |
| Kay Schumacher |
Contracted Managing Employee |
Jan 15, 2018 | |
| Benedictine Health System |
5% Or Greater Indirect Ownership Interest | Dec 15, 2017 | 50% |
| Operational/Managerial Control | Dec 15, 2017 | 100% |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20171220000494 | MN | Part a Provider - Skilled Nursing Facility | 9335407378 | Practice locations: Saint Paul, MN |
National Provider Directory
Locations
1995 E Rum River Dr S
Cambridge, MN 55008
6499 University Ave NE
Minneapolis, MN 55432
Phone (612) 486-2134
200 Earl St
Saint Paul, MN 55106
Phone (651) 771-2914
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Skilled Nursing Facility | 314000000X | Yes |
Addresses
Primary practice location
200 Earl St
Saint Paul, MN 55106-6714
Mailing address
6499 University Ave NE
Minneapolis, MN 55432-4303
Other providers in Saint Paul, MN
- Ariel Roman Centurion
- Cerenity Senior Care
- Cerenity Senior Care
- Cerenity Senior Care
- Cerenity Senior Care
- Ericka A Cermak
- Peter Cermak
- Jasmine Ceron
- Chue Ying Cha
- Yer Ton Cha
All providers in Saint Paul, MN · Skilled Nursing Facility in Minnesota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 28, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.