NPIMap

Organization Active NPI

St Marys Regional Health Center

Doing business as Essentia Health Home Care West

  • Home Health Agency
  • Detroit Lakes, MN
National Provider Identifier
1720078686
Registry record updated Mar 1, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Home Health AgencyTaxonomy code 251E00000X
Legal business name
ST MARYS REGIONAL HEALTH CENTER
Doing business as
Essentia Health Home Care West
Practice address
114 Frazee St E
Detroit Lakes, MN 56501
Phone
(218) 847-0808
Fax
(218) 847-0850
NPI assigned
Oct 24, 2005
Last updated
Mar 1, 2024By the provider in NPPES
Organization subpart
Yes
Parent organization
ESSENTIA HEALTHAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 1, 2024

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

Authorized official

Name
Alan James Hurley
Title
Coo
Phone
(979) 820-4247

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Community Health Registered NurseGroup: 193400000X SINGLE SPECIALTY GROUP 163WC1500X
Home Health Agency 251E00000X Primary

Addresses

Primary practice location

114 Frazee St E
Detroit Lakes, MN 56501

Mailing address

114 Frazee St E
Detroit Lakes, MN 56501-3502
Phone (218) 847-0808

Other practice location 1

201 9th St W
Ada, MN 56510-1279
Phone (218) 784-2205

Other practice location 2

3362 35th Ave S
Fargo, ND 58104-8835
Phone (701) 364-3010

Other practice location 3

900 Hilligoss Blvd SE
Fosston, MN 56542-1542
Phone (218) 435-7670

Other names 1

  • Essentia Health Home Care West Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20060330000577 MN Part A Provider - Home Health Agency 2062326820 Practice locations: Fosston, MN; Fargo, ND; Detroit Lakes, MN; Ada, MN

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1720078686. Details of each certification follow.

Home health agency certification: CCN 248052

Legal name
ST MARYS REGIONAL HEALTH CENTER
Doing business as
ESSENTIA HEALTH HOME CARE WEST
Certification status
Active
Provider type (POS)
Home health agency
Participating since
Feb 27, 1997
Last certification
Sep 14, 2018
Ownership / control type
Non-Profit
Organization structure
CorporationNon-profit
Enrollment address
114 Frazee St E
Detroit Lakes, MN 56501-3502

Other NPIs with the same Medicare PAC ID 11

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

Care Compare: Home health agency

Medicare Care Compare
Listed as
Essentia Health Home Care WestCCN 248052 · All quality measures
Overall star rating
4 of 5
Ownership
Non-Profit
Certified
Feb 27, 1997
Medicare certification status
ActiveFrom the Provider of Services file
Services
Nursing, Medical social, Home health aide, Physical therapy, Speech pathology, Occupational therapy

National Provider Directory

National Provider Directory
Tax ID family
St Marys Regional Healt11 organizations share this tax ID, including this one

Other organizations with this tax ID 10

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

Member of 1

Organizations this organization is a member of, according to 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
Stefanie Gefroh Ellison Individual Corporate OfficerPresident Aug 12, 2024
Tim D Heilman Individual Corporate DirectorBoard Member Jan 1, 2020
Marc Adams Individual Corporate DirectorBoard Member Jan 1, 2026
Mark Krejci Individual Corporate DirectorBoard Member Jan 1, 2026
Kimberly Pladson Individual Corporate DirectorBoard Member Jan 1, 2025
Essentia Health Organization, Duluth, MN Non-profit 5% Or Greater Direct Ownership Interest Jul 1, 2023 100%
James M Christensen Individual Corporate DirectorBoard Member Jan 1, 2020
Kevin S Boren Individual Corporate OfficerTreasurer Sep 29, 2025
Taylor Grant Mertz Individual Corporate DirectorBoard Member May 17, 2022
Anderson Saint Georges Individual Corporate DirectorBoard Member Jan 1, 2025
Michael Watters Individual Corporate OfficerSecretary Jul 1, 2023
Alan J Hurley Individual Corporate OfficerCoo May 18, 2023
W-2 Managing EmployeeCoo May 18, 2023
Benjamin Cody Smith Individual Corporate DirectorBoard Member May 17, 2022
Douglas J Arvin Individual Corporate OfficerVP of Finance May 18, 2023
W-2 Managing EmployeeVP of Finance May 18, 2023
Laurie Ann Lewandowski Individual Corporate DirectorBoard Member Jan 1, 2017
Innovis Health LLC Organization, Fargo, ND Non-profit Operational/Managerial Control Jan 1, 2011

Owners & managing parties with NPI records 11

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

Facilities with the same owner 50

Facilities that share an organizational owner with 5% or greater ownership or operational control.

View all 50

Practitioners & affiliated clinicians

Affiliated clinicians 53

Clinicians who list this facility as an affiliation in Medicare Care Compare.

View all 53

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1130112000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1709251200000",
    "number": "1720078686",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "114 FRAZEE ST E",
            "city": "DETROIT LAKES",
            "state": "MN",
            "postal_code": "565013502",
            "telephone_number": "218-847-0808",
            "fax_number": "218-847-0850"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "114 FRAZEE ST E",
            "city": "DETROIT LAKES",
            "state": "MN",
            "postal_code": "56501",
            "telephone_number": "218-847-0808",
            "fax_number": "218-847-0850"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "201 9th St W",
            "address_purpose": "LOCATION",
            "city": "Ada",
            "state": "MN",
            "postal_code": "565101279",
            "country_code": "US",
            "telephone_number": "218-784-2205",
            "fax_number": "218-784-2207",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3362 35th Ave S",
            "address_purpose": "LOCATION",
            "city": "Fargo",
            "state": "ND",
            "postal_code": "581048835",
            "country_code": "US",
            "telephone_number": "701-364-3010",
            "fax_number": "701-364-3011",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "900 Hilligoss Blvd SE",
            "address_purpose": "LOCATION",
            "city": "Fosston",
            "state": "MN",
            "postal_code": "565421542",
            "country_code": "US",
            "telephone_number": "218-435-7670",
            "fax_number": "218-435-2175",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "ST MARYS REGIONAL HEALTH CENTER",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "ESSENTIA HEALTH",
        "enumeration_date": "2005-10-24",
        "last_updated": "2024-03-01",
        "certification_date": "2024-03-01",
        "status": "A",
        "authorized_official_last_name": "HURLEY",
        "authorized_official_first_name": "ALAN",
        "authorized_official_middle_name": "JAMES",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "979-820-4247"
    },
    "taxonomies": [
        {
            "code": "163WC1500X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Registered Nurse, Community Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "251E00000X",
            "taxonomy_group": "",
            "desc": "Home Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Essentia Health Home Care West",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Detroit Lakes, MN

Sources for this page

Verify at the official NPI Registry.