NPIMap

Organization Active NPI

Minnesota Hospice LLC

  • Community Based Hospice Care Agency
  • Lakeville, MN
National Provider Identifier
1891066239
Registry record updated Aug 23, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Based Hospice Care AgencyTaxonomy code 251G00000X
License
379554 Issued in MN
Legal business name
MINNESOTA HOSPICE LLC
Practice address
17645 Juniper Path
Suite 155
Lakeville, MN 55044-7490
Phone
(952) 898-1022
Fax
(952) 898-4006
NPI assigned
Jan 17, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 23, 2017

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

Authorized official

Name
Kenneth Haglind
Title
President
Phone
(952) 898-1022

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Community Based Hospice Care Agency 251G00000X 355830 MN
Community Based Hospice Care Agency 251G00000X 379554 MN Primary

Addresses

Primary practice location

17645 Juniper Path
Suite 155
Lakeville, MN 55044-7490

Mailing address

17645 Juniper Path
Suite 155
Lakeville, MN 55044-7577
Phone (952) 898-1022

Other identifiers 1

IdentifierTypeStateIssuer
131614MedicaidMN

Other names 1

  • Hospice Advantage, Inc. Former legal business name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20170202002549 MN Part A Provider - Hospice 7012290729 Practice locations: Lakeville, MN

Hospice certification: CCN 241582

Legal name
MINNESOTA HOSPICE LLC
Certification status
Active
Provider type (POS)
Hospice
Participating since
Feb 15, 2008
Last certification
Oct 28, 2021
Ownership / control type
Proprietary - Other
Organization structure
LLCProprietary
Incorporated
Aug 26, 2016 in MN
Enrollment address
17645 Juniper Path
Ste 155
Lakeville, MN 55044-7577

Care Compare: Hospice

Medicare Care Compare
Listed as
Minnesota Hospice LLCCCN 241582
Ownership
For-Profit
Certified
Feb 15, 2008
Medicare certification status
ActiveFrom the Provider of Services file

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
24D1074756Minnesota Hospice17645 Juniper Path Suite 155, Lakeville, MN 55044Certificate of waiverSep 7, 2027

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

17645 Juniper Path
Ste 155
Lakeville, MN 55044
Phone (952) 207-0723

Ownership & related parties

All disclosed owners & managing parties 3

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

NameRoleSinceShare
Kenneth N Haglind Individual 5% Or Greater Direct Ownership Interest Apr 29, 2019 46.34%
Corporate OfficerPresident Apr 29, 2019 46.34%
Corporate DirectorPresident Apr 29, 2019 46.34%
Operational/Managerial ControlPresident Apr 29, 2019 46.34%
David Lee Gilbertson Individual 5% Or Greater Direct Ownership Interest Apr 29, 2019 46.34%
Corporate OfficerChief Medical Officer Apr 29, 2019 46.34%
Corporate DirectorChief Medical Officer Apr 29, 2019 46.34%
Operational/Managerial ControlChief Medical Officer Apr 29, 2019 46.34%
Robert J Beck Individual 5% Or Greater Direct Ownership Interest Apr 29, 2019 7.32%

Owners & managing parties with NPI records 1

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

  • David Lee Gilbertson, D.O.
    • Hospice and Palliative Medicine (Internal Medicine) Physician
    • Lakeville, MN
    • NPI 1962516575

    5% Or Greater Direct Ownership Interest, Corporate Director, Corporate Officer, Operational/Managerial Control

    CMS ownership

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

Affiliated clinicians 42

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

View all 42

NPI Registry JSON

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

{
    "created_epoch": "1326758400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1503446400000",
    "number": "1891066239",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17645 JUNIPER PATH",
            "address_2": "SUITE 155",
            "city": "LAKEVILLE",
            "state": "MN",
            "postal_code": "550447577",
            "telephone_number": "952-898-1022",
            "fax_number": "952-898-4006"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17645 JUNIPER PATH",
            "address_2": "SUITE 155",
            "city": "LAKEVILLE",
            "state": "MN",
            "postal_code": "550447490",
            "telephone_number": "952-898-1022",
            "fax_number": "952-898-4006"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MINNESOTA HOSPICE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-01-17",
        "last_updated": "2017-08-23",
        "status": "A",
        "authorized_official_last_name": "HAGLIND",
        "authorized_official_first_name": "KENNETH",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "952-898-1022"
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": "MN",
            "license": "355830",
            "primary": false
        },
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": "MN",
            "license": "379554",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "131614",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Hospice Advantage, Inc.",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Lakeville, MN

Sources for this page

Verify at the official NPI Registry.