NPIMap

Organization Active NPI

Lifecare Medical Center

  • Skilled Nursing Facility
  • Roseau, MN
National Provider Identifier
1679569834
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 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
Last updated
Jul 21, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Authorized official

Name
Catherine A. Huss
Title
Cfo
Phone
(218) 463-4763

Specialties & licenses 1

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

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 names 1

  • LIFECARE ROSEAU MANOR Other name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20060307000389 MN Part A Provider - Skilled Nursing Facility 4789586884 Practice locations: Roseau, MN

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1679569834. Details of each certification follow.

Skilled nursing facility certification: CCN 245470A

Legal name
LIFECARE MEDICAL CENTER
Organization structure
CorporationNon-profit
Incorporated
Oct 1, 1995 in MN
Enrollment address
715 Delmore Dr
Roseau, MN 56751-1534
Nursing home name
LIFECEARE ROSEAU MANOR

Other NPIs with the same Medicare PAC ID 8

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Roseau Area Hospital an8 organizations share this tax ID, including this one

Other organizations with this tax ID 7

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 16

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

NameRoleSinceShare
Keith W Okeson Individual Corporate OfficerCeo Jul 31, 2005
Managing Control - Governing BodyCeo Jul 31, 2005
Chuck D Lindner Individual Corporate DirectorBoard Member Sep 1, 2007
Beth L Johnson Individual Corporate DirectorBoard Member Oct 1, 2015
Corwin D Vatnsdal Individual Corporate DirectorBoard Member Oct 1, 2007
Therese a McBride Individual Corporate DirectorBoard Member Aug 1, 1995
Catherine a Huss Individual Corporate OfficerCfo Dec 5, 2000
Operational/Managerial Control Dec 5, 2000
Managing Control - Governing BodyCfo Dec 5, 2000
Shannon Carlson Individual Operational/Managerial Control Mar 3, 1997
Adp of the SNF Apr 17, 2026
Mark W Wilson Individual Corporate DirectorBoard Member Oct 1, 2009
Ronald W Brummer Individual Corporate DirectorBoard Member Apr 29, 2019
Mark T Karl Individual Corporate DirectorBoard Member Aug 22, 2016
Stuart Wade McFarlane Individual Corporate Director Nov 1, 2025
Dan a Urness Individual Corporate DirectorBoard Member Aug 22, 2016
Jessica R Foss Individual Corporate DirectorBoard Member Oct 1, 2015
Michelle Didrikson Individual Corporate Director Jan 1, 2026
Gabriel D Mooney Individual Corporate DirectorBoard Member Aug 1, 2025
Bryon D Vande Wege Individual Operational/Managerial Control Jan 15, 2016
Adp of the SNF Apr 17, 2026

Owners & managing parties with NPI records 2

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

Practitioners & affiliated clinicians

Practitioners 1

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": "1127433600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1679569834",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "715 DELMORE DR",
            "city": "ROSEAU",
            "state": "MN",
            "postal_code": "567511534",
            "telephone_number": "218-463-2500",
            "fax_number": "218-463-4782"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "715 DELMORE DR",
            "city": "ROSEAU",
            "state": "MN",
            "postal_code": "567511534",
            "telephone_number": "218-463-2500",
            "fax_number": "218-463-4782"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFECARE MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-09-23",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "HUSS",
        "authorized_official_first_name": "CATHERINE",
        "authorized_official_middle_name": "A.",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "218-463-4763"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "MN",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "LIFECARE ROSEAU MANOR",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Roseau, MN

Sources for this page

Verify at the official NPI Registry.