Lifecare Medical Center
Organization Active NPI Skilled Nursing Facility · Roseau, MN
NPI 1679569834 · NPPES record last updated Jul 21, 2022
Key facts
- NPI
- 1679569834
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Skilled Nursing Facility 314000000X
- Legal business name
- LIFECARE MEDICAL CENTER
- Practice address
- 715 Delmore Dr
Roseau, MN 56751-1534 - Phone
- (218) 463-2500
- Fax
- (218) 463-4782
- NPI assigned
- Sep 23, 2005
- Organization subpart
- No
Authorized official
- Name
- Catherine A. Huss
- Title
- Cfo
- Phone
- (218) 463-4763
Owners & managing parties with NPI records 2
-
Ronald W Brummer, MD
Other NPIs with the same Medicare PAC ID 8
Corporate family (same tax ID) 7
Practitioners 55
-
Shivali Devgon, MD
-
Miranda Ann Marie Bernath, FNP-C
-
James M Cain, MD
-
Quinn H Carmichael, M.D.
-
Anne T Goldschmidt, M.D.
-
Benjamin Matthew Graham, PA-C
-
Joshua Daniel Heaton, M.D.
-
Shih-an John Hsieh, M.D.
-
Aunica Isane, PA-C
-
Bryan Mikael Johnson, PA-C
-
Allyssa Jonsson, DO
-
Nicole Marie Kiesow, PA-C
-
Benjamin Andrew Kitt, D.O.
-
Rachel Landman, FNP
-
Martha J Lystad, NP
-
Sadia Munawar, MD
-
Prasad Munusamy, M.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MN
Skilled nursing facility certification: CCN 245470A
- Legal name
- LIFECARE MEDICAL CENTER
- Organization structure
- Corporation · Non-profit
- Incorporated
- Oct 1, 1995 in MN
- Enrollment address
- 715 Delmore Dr
Roseau, MN 56751-1534 - Nursing home name
- LIFECEARE ROSEAU MANOR
All disclosed owners & managing parties 16
| Name | Role | Since | Share |
|---|---|---|---|
| Keith W Okeson |
Corporate Officer |
Jul 31, 2005 | |
| Managing Control - Governing Body |
Jul 31, 2005 | ||
| Chuck D Lindner |
Corporate Director |
Sep 1, 2007 | |
| Beth L Johnson |
Corporate Director |
Oct 1, 2015 | |
| Corwin D Vatnsdal |
Corporate Director |
Oct 1, 2007 | |
| Therese a McBride |
Corporate Director |
Aug 1, 1995 | |
| Catherine a Huss |
Corporate Officer |
Dec 5, 2000 | |
| Operational/Managerial Control | Dec 5, 2000 | ||
| Managing Control - Governing Body |
Dec 5, 2000 | ||
| Shannon Carlson |
Operational/Managerial Control | Mar 3, 1997 | |
| Adp of the SNF | Apr 17, 2026 | ||
| Mark W Wilson |
Corporate Director |
Oct 1, 2009 | |
| Ronald W Brummer |
Corporate Director |
Apr 29, 2019 | |
| Mark T Karl |
Corporate Director |
Aug 22, 2016 | |
| Stuart Wade McFarlane |
Corporate Director | Nov 1, 2025 | |
| Dan a Urness |
Corporate Director |
Aug 22, 2016 | |
| Jessica R Foss |
Corporate Director |
Oct 1, 2015 | |
| Michelle Didrikson |
Corporate Director | Jan 1, 2026 | |
| Gabriel D Mooney |
Corporate Director |
Aug 1, 2025 | |
| Bryon D Vande Wege |
Operational/Managerial Control | Jan 15, 2016 | |
| Adp of the SNF | Apr 17, 2026 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20060307000389 | MN | Part a Provider - Skilled Nursing Facility | 4789586884 | Practice locations: Roseau, MN |
National Provider Directory
- Tax ID family
- Lifecare Medical Center
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Skilled Nursing Facility | 314000000X | MN | Yes |
Addresses
Primary practice location
715 Delmore Dr
Roseau, MN 56751-1534
Mailing address
715 Delmore Dr
Roseau, MN 56751-1534
Phone (218) 463-2500
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 842724100 | Medicaid | MN | |
| NH0427 | Other | MN | UCARE |
Other names
- LIFECARE ROSEAU MANOR
Other providers in Roseau, MN
- Lifecare Medical Center
- Lifecare Medical Center
- Lifecare Medical Center
- Lifecare Medical Center
- Lifecare Medical Center
- Lifecare Medical Center
- Lifecare Medical Center
- Lorris G. Vatnsdal, LTD.
- Jack Victor Lundbohm
- Renae J Matthews
All providers in Roseau, 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 Jul 21, 2022. 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.