NPIMap

Organization Active NPI

City of Lakes Care Center

Doing business as Benedictine Health Center of Minneapolis

  • Skilled Nursing Facility
  • Minneapolis, MN
National Provider Identifier
1669478129
Registry record updated Feb 20, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
327352 Issued in MN
Legal business name
CITY OF LAKES CARE CENTER
Doing business as
Benedictine Health Center of Minneapolis
Practice address
618 E 17TH St
Minneapolis, MN 55404-1506
Phone
(612) 879-2811
Fax
(612) 879-2917
NPI assigned
Jun 21, 2005
Last updated
Feb 20, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 20, 2025

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

Authorized official

Name
Mr. Peter Momanyi, LNHA
Title
Administrator / Ceo
Phone
(612) 879-2800

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X 327352 MN Primary

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 1

IdentifierTypeStateIssuer
19667740MedicaidMN

Other names 1

  • Benedictine Health Center of Minneapolis Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20021010000022 MN Part A Provider - Skilled Nursing Facility 1557278124 Practice locations: Minneapolis, MN

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1669478129. Details of each certification follow.

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
CorporationNon-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

Care Compare: Nursing home

Medicare Care Compare
Listed as
Benedictine Health Center of MinneapolisCCN 245266 · All quality measures
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
ActiveFrom the Provider of Services file
Certified beds
9085.3 residents per day on average
Chain
Benedictine Health System23 facilities in the chain
Penalties (3 years)
2Fines totaling $84,774

Processed by Care Compare on Aug 1, 2026.

National Provider Directory

National Provider Directory

Locations

618 E 17th St
Minneapolis, MN 55404
Phone (612) 332-3541

Ownership & related parties

All disclosed owners & managing parties 11

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

NameRoleSinceShare
John W Mielke Individual Operational/Managerial Control Apr 11, 2025
Adp of the SNF Apr 11, 2025
Organization, Tallahassee, FL Corporation Adp of the SNF May 9, 2025
Kevin J Rymanowski Individual Corporate OfficerTreasurer Jan 1, 2008
Theresa Kay Will Individual Corporate DirectorBoard Member Feb 1, 2025
Tricia Bergien Individual Corporate OfficerAssistant Treasurer Nov 1, 2016
Taylar Hack Individual Corporate DirectorExofficio Jul 1, 2022
Peter Momanyi Individual Operational/Managerial Control Aug 25, 2022
Adp of the SNF Jun 18, 2025
David Hoel Individual Corporate DirectorChairperson Sep 1, 2015
Lynette Pearson Individual Corporate DirectorBoard Member Jul 1, 2021
Jeffrey Benson Individual Corporate DirectorVice Chairperson/Board Member Aug 6, 2014
Benedictine Health System Organization, Minneapolis, MN Corporation, Management services company, Non-profit, Chain home office 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%

Owners & managing parties with NPI records 1

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

  • John W Mielke, M.D.
    • Geriatric Medicine (Internal Medicine) Physician
    • Minneapolis, MN
    • NPI 1679508006

    Adp of the SNF, Operational/Managerial Control

    CMS ownership

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.

Affiliated clinicians 3

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": "1119312000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1740009600000",
    "number": "1669478129",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "618 E 17TH ST",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554041506",
            "telephone_number": "612-879-2811",
            "fax_number": "612-879-2917"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "618 E 17TH ST",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554041506",
            "telephone_number": "612-879-2811",
            "fax_number": "612-879-2917"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CITY OF LAKES CARE CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-06-21",
        "last_updated": "2025-02-20",
        "certification_date": "2025-02-20",
        "status": "A",
        "authorized_official_last_name": "MOMANYI",
        "authorized_official_first_name": "PETER",
        "authorized_official_title_or_position": "ADMINISTRATOR / CEO",
        "authorized_official_telephone_number": "612-879-2800",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "LNHA"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "MN",
            "license": "327352",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "19667740",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Benedictine Health Center of Minneapolis",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Benedictine Health Center of Minneapolis",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Minneapolis, MN

Sources for this page

Verify at the official NPI Registry.