Estates at Roseville LLC
Organization Active NPI Skilled Nursing Facility · Roseville, MN
NPI 1861930331 · NPPES record last updated Feb 6, 2017
Key facts
- NPI
- 1861930331
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Skilled Nursing Facility 314000000X
- Legal business name
- ESTATES AT ROSEVILLE LLC
- Practice address
- 2727 Victoria St N
Roseville, MN 55113-3029 - Phone
- (507) 625-8741
- NPI assigned
- Feb 6, 2017
- Organization subpart
- No
Authorized official
- Name
- Joshua Legum
- Title
- Ceo
- Phone
- (507) 625-8741
Facilities with the same owner 44
Practitioners 5
-
Gehad Adel Elfarra, M.D
-
Brent S Williams, MD
Affiliated clinicians 3
-
Gehad Adel Elfarra, M.D
Medicare Care Compare: Nursing home
- Listed as
- The Estates at Roseville LLC
- Overall star rating
- ★★☆☆☆ 2 of 5
- Health inspections
- ★★☆☆☆ 2 of 5
- Staffing
- ★★★★☆ 4 of 5
- Quality measures
- ★★★★☆ 4 of 5
- Type
- Medicare and Medicaid
- Ownership
- For profit - Corporation
- Certified
- Aug 1, 1969
- Medicare certification status
- Active
- Certified beds
- 140 · 134.2 residents per day on average
- Chain
- Monarch Healthcare Management
- Penalties (3 years)
- 1 · fines totaling $27,378
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 24D0855959 | The Estates at Roseville | Certificate of waiver | Aug 31, 2026 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MN
Skilled nursing facility certification: CCN 245105
- Legal name
- ESTATES AT ROSEVILLE LLC
- Certification status
- Active
- Provider type (POS)
- Nursing home – SNF/NF dual certification
- Participating since
- Aug 1, 1969
- Last certification
- May 21, 2025
- Beds
- 140
- Ownership / control type
- Corporation
- Multi-facility organization
- The estates
- Organization structure
- LLC · Proprietary
- Incorporated
- Dec 30, 2016 in MN
- Enrollment address
- 2727 N Victoria
Roseville, MN 55113-2098 - Nursing home name
- THE ESTATES AT ROSEVILLE LLC
- Affiliated entity
- MONARCH HEALTHCARE MANAGEMENT
All disclosed owners & managing parties 9
| Name | Role | Since | Share |
|---|---|---|---|
| Spartan Healthcare LLC |
5% Or Greater Direct Ownership Interest | Mar 1, 2017 | 30% |
| William Stern |
5% Or Greater Direct Ownership Interest | Mar 1, 2017 | 20% |
| Corporate Officer |
Mar 1, 2017 | 20% | |
| Operational/Managerial Control | Mar 1, 2017 | ||
| Marc Halpert |
5% Or Greater Indirect Ownership Interest | Mar 1, 2017 | 30% |
| Corporate Director |
Mar 1, 2017 | 30% | |
| Jeffrey Arem |
5% Or Greater Direct Ownership Interest |
Mar 1, 2017 | |
| Monarch Healthcare Operating IV LLC |
Operational/Managerial Control | Mar 1, 2017 | 100% |
| Joshua Legum |
5% Or Greater Indirect Ownership Interest | Mar 1, 2017 | 30% |
| W-2 Managing Employee |
Mar 1, 2017 | ||
| Yazoma Holdings, LLC |
5% Or Greater Direct Ownership Interest | Mar 1, 2017 | 30% |
| Noam Jaffa |
5% Or Greater Indirect Ownership Interest | Mar 1, 2017 | 6.68% |
| Nij LLC |
5% Or Greater Direct Ownership Interest | Mar 1, 2017 | 6.68% |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20170404000715 | MN | Part a Provider - Skilled Nursing Facility | 1951687078 | Practice locations: Roseville, MN |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Skilled Nursing Facility | 314000000X | Yes |
Addresses
Primary practice location
2727 Victoria St N
Roseville, MN 55113-3029
Mailing address
638 Southbend Ave
Mankato, MN 56001-2168
Phone (507) 625-8741
Other providers in Roseville, MN
- Deborah Kay Erickson
- James Arthur Erickson
- Nicollette Erickson
- Erskine M Caperton MD PA
- Essential Home LLC
- Bruce Estrem
- Christine Jill Etter
- Anton Dante Evans
- Trevor Lee Everett
- Expressive Minds, LLC
All providers in Roseville, 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 Feb 6, 2017. 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.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.