Active NPI
Lifecare Medical Center
- Community Based Hospice Care Agency
- Roseau, MN
National Provider Identifier
1760478929
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Community Based Hospice Care Agency
- 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, 2022
- Organization subpart
- No
NPPES NPI Registry
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) | Code | License | State | Primary |
|---|---|---|---|---|
| Community Based Hospice Care Agency | 251G00000X | 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 identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 9A23HRO | Other | MN | BLUE CROSS MN |
| 342547900 | Medicaid | MN |
Other names 1
- LIFECARE HOSPICE
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MN
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20060307000403 | MN | Part A Provider - Hospice | 4789586884 | Practice locations: Roseau, MN |
NPI to CCN mapping 1
The Medicare certification numbers (CCNs) connected to NPI 1760478929. Details of each certification follow.
Hospice certification: CCN 241563
- Legal name
- LIFECARE MEDICAL CENTER
- Doing business as
- LIFECARE HOSPICE
- Certification status
- Active
- Provider type (POS)
- Hospice
- Participating since
- Feb 7, 1997
- Last certification
- Dec 7, 2018
- Ownership / control type
- Non-Profit - Private
- Organization structure
- Other
- Incorporated
- Oct 1, 1995 in MN
- Enrollment address
- 715 Delmore Dr
Roseau, MN 56751-1534
Other NPIs with the same Medicare PAC ID 8
NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).
-
dba Lifecare Clinic Roseau
- Rural Health Clinic/Center
- Roseau, MN
- NPI 1225885676
4789586884
-
- Medicare Defined Swing Bed Hospital Unit
- Roseau, MN
- NPI 1235268350
4789586884
-
dba Lifecare Clinic Greenbush
- Rural Health Clinic/Center
- Greenbush, MN
- NPI 1558118919
4789586884
-
dba Lifecare Clinic Warroad
- Rural Health Clinic/Center
- Warroad, MN
- NPI 1619724077
4789586884
Care Compare: Hospice
Medicare Care Compare- Listed as
- Lifecare Hospice
- Ownership
- Non-Profit
- Certified
- Feb 7, 1997
- Medicare certification status
- Active
National Provider Directory
National Provider DirectoryOwnership & related parties
All disclosed owners & managing parties 15
As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.
| Name | Role | Since | Share |
|---|---|---|---|
| Keith W Okeson | Corporate Officer | Jul 31, 2005 | |
| W-2 Managing Employee | 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 | |
| W-2 Managing Employee | Dec 5, 2000 | ||
| Shayne K Isane | Corporate Director | Mar 1, 2012 | |
| Mark W Wilson | Corporate Director | Oct 1, 2009 | |
| Ronald W Brummer | Corporate Director | Apr 1, 2019 | |
| Mark T Karl | Corporate Director | Aug 22, 2016 | |
| Brenda K Sather | Corporate Director | Oct 1, 2009 | |
| Dan a Urness | Corporate Director | Aug 22, 2016 | |
| Jessica R Foss | Corporate Director | Oct 1, 2015 | |
| Matthew L Ulwelling | Corporate Director | Nov 1, 2013 | |
| Megan S Comstock | Corporate Director | Feb 28, 2022 |
Owners & managing parties with NPI records 1
Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.
Practitioners & affiliated clinicians
Affiliated clinicians 2
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": "1127433600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1658361600000",
"number": "1760478929",
"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": "251G00000X",
"taxonomy_group": "",
"desc": "Hospice Care, Community Based",
"state": "MN",
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS MN",
"identifier": "9A23HRO",
"state": "MN"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "342547900",
"state": "MN"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "LIFECARE HOSPICE",
"code": "5",
"type": "Other Name"
}
]
}Other providers in Roseau, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.