City of Lakes Care Center
Organization Active NPI Skilled Nursing Facility · Minneapolis, MN
NPI 1669478129 · NPPES record last updated Feb 20, 2025
Key facts
- NPI
- 1669478129
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Skilled Nursing Facility 314000000X
- License
- 327352 (MN)
- Legal business name
- CITY OF LAKES CARE CENTER
- Practice address
- 618 E 17TH St
Minneapolis, MN 55404-1506 - Phone
- (612) 879-2811
- Fax
- (612) 879-2917
- NPI assigned
- Jun 21, 2005
- Organization subpart
- No
Authorized official
- Name
- Mr. Peter Momanyi, LNHA
- Title
- Administrator / Ceo
- Phone
- (612) 879-2800
Owners & managing parties with NPI records 1
-
John W Mielke, M.D.
Facilities with the same owner 27
Practitioners 5
-
Lea Caitlin Buda, DO
-
John W Mielke, M.D.
-
Kerry M Sheets, MD
Affiliated clinicians 3
-
Kerry M Sheets, MD
Medicare Care Compare: Nursing home
- Listed as
- Benedictine Health Center of Minneapolis
- Overall star rating
- ★★★☆☆ 3 of 5
- Health inspections
- ★★☆☆☆ 2 of 5
- Staffing
- ★★★★★ 5 of 5
- Quality measures
- ★★★☆☆ 3 of 5
- Type
- Medicare and Medicaid
- Ownership
- Non profit - Corporation
- Certified
- Feb 24, 1984
- Medicare certification status
- Active
- Certified beds
- 90 · 85.3 residents per day on average
- Chain
- Benedictine Health System
- Penalties (3 years)
- 2 · fines totaling $84,774
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MN
Skilled nursing facility certification: CCN 245266
- Legal name
- CITY OF LAKES CARE CENTER
- Doing business as
- BENEDICTINE HEALTH CENTER OF MINNEAPOLIS
- Certification status
- Active
- Provider type (POS)
- Nursing home – SNF/NF dual certification
- Participating since
- Feb 24, 1984
- Last certification
- Jan 16, 2025
- Beds
- 95 (90 certified)
- Ownership / control type
- Nonprofit Corporation
- Multi-facility organization
- Benedictine Health System
- Organization structure
- Corporation · Non-profit
- Incorporated
- Oct 2, 2000 in MN
- Enrollment address
- 618 E 17TH Street
Minneapolis, MN 55404-1506 - Nursing home name
- BENEDICTINE HEALTH CENTER OF MINNEAPOLIS
- Affiliated entity
- BENEDICTINE HEALTH SYSTEM
All disclosed owners & managing parties 11
| Name | Role | Since | Share |
|---|---|---|---|
| John W Mielke |
Operational/Managerial Control | Apr 11, 2025 | |
| Adp of the SNF | Apr 11, 2025 | ||
| |
Adp of the SNF | May 9, 2025 | |
| Kevin J Rymanowski |
Corporate Officer |
Jan 1, 2008 | |
| Theresa Kay Will |
Corporate Director |
Feb 1, 2025 | |
| Tricia Bergien |
Corporate Officer |
Nov 1, 2016 | |
| Taylar Hack |
Corporate Director |
Jul 1, 2022 | |
| Peter Momanyi |
Operational/Managerial Control | Aug 25, 2022 | |
| Adp of the SNF | Jun 18, 2025 | ||
| David Hoel |
Corporate Director |
Sep 1, 2015 | |
| Lynette Pearson |
Corporate Director |
Jul 1, 2021 | |
| Jeffrey Benson |
Corporate Director |
Aug 6, 2014 | |
| Benedictine Health System |
5% Or Greater Direct Ownership Interest | Oct 2, 2000 | 100% |
| Operational/Managerial Control | Oct 2, 2000 | 100% | |
| Adp of the SNF | Oct 2, 2000 | ||
| Direct Ownership Interest | Oct 2, 2000 | 100% |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20021010000022 | MN | Part a Provider - Skilled Nursing Facility | 1557278124 | Practice locations: Minneapolis, MN |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Skilled Nursing Facility | 314000000X | 327352 | MN | Yes |
Addresses
Primary practice location
618 E 17TH St
Minneapolis, MN 55404-1506
Mailing address
618 E 17TH St
Minneapolis, MN 55404-1506
Phone (612) 879-2811
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 19667740 | Medicaid | MN |
Other names
- Benedictine Health Center of Minneapolis
Other providers in Minneapolis, MN
- Lisa A. Citak
- Citiwide Home Health Inc
- City Chiropractic, PC
- City Clinic Inc
- City Lakes Chiropractic PA
- City of Lakes Dental, P.a.
- City of Minneapolis
- City Tour Transportatio LLC
- Citycare Wellness LLC
- Cityscape Dental PA
All providers in Minneapolis, 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 Feb 20, 2025. 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.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.