NPIMap

Organization Active NPI

Lifecare Medical Center

  • Skilled Nursing Facility
  • Greenbush, MN
National Provider Identifier
1891780516
Registry record updated May 31, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
License
346331 Issued in MN
Legal business name
LIFECARE MEDICAL CENTER
Practice address
152 5TH St S
Greenbush, MN 56726-4406
Phone
(218) 782-2131
Fax
(218) 782-4005
NPI assigned
Sep 19, 2005
Last updated
May 31, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 31, 2013

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 346331 MN Primary

Addresses

Primary practice location

152 5TH St S
Greenbush, MN 56726-4406

Mailing address

715 Delmore Dr
Roseau, MN 56751-1534
Phone (218) 463-2500

Other identifiers 2

IdentifierTypeStateIssuer
NH0426OtherMNUCARE
850026600MedicaidMN

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100310000812 MN Part A Provider - Skilled Nursing Facility 4789586884 1 other NPI on this enrollment
Practice locations: Greenbush, MN

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1891780516. Details of each certification follow.

Skilled nursing facility certification: CCN 245616

Legal name
LIFECARE MEDICAL CENTER
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF distinct part
Participating since
Apr 13, 2009
Last certification
May 14, 2025
Beds
40
Ownership / control type
Nonprofit Corporation
Multi-facility organization
LifeCare Medical Center
Organization structure
CorporationNon-profit
Incorporated
Oct 1, 1995 in MN
Enrollment address
19120 200TH St
Greenbush, MN 56726-9280
Nursing home name
LIFECARE GREENBUSH MANOR

Other NPIs with the same Medicare PAC ID 8

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

Care Compare: Nursing home

Medicare Care Compare
Listed as
Lifecare Greenbush ManorCCN 245616 · All quality measures
Overall star rating
5 of 5
Health inspections
5 of 5
Staffing
5 of 5
Quality measures
3 of 5
Type
Medicare and Medicaid
Ownership
Non profit - Corporation
Certified
Apr 13, 2009
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
4035.0 residents per day on average

Processed by Care Compare on Aug 1, 2026.

National Provider Directory

National Provider Directory
Tax ID family
Lifecare Medical Center8 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 8

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 Officer Jul 31, 2005
Operational/Managerial Control Jul 31, 2005
Managing Control - Governing Body Jul 31, 2005
Adp of the SNF Jul 31, 2005
Beth L Johnson Individual Corporate DirectorBoard Member Oct 1, 2015
Catherine a Huss Individual Corporate OfficerCfo Dec 5, 2000
Operational/Managerial Control Dec 5, 2000
Managing Control - Governing Body Dec 5, 2000
Adp of the SNF Dec 5, 2000
Shannon Carlson Individual Operational/Managerial Control Mar 3, 1997
Managing Control - Governing BodyAdministrator Mar 3, 1997
Adp of the SNF Apr 1, 2026
Stuart Wade McFarlane Individual Corporate Director Nov 1, 2025
Michelle Didrikson Individual Corporate Director Jan 1, 2026
Gabriel D Mooney Individual Corporate Director Aug 1, 2025
Bryon D Vande Wege Individual Operational/Managerial Control Jan 15, 2016
Adp of the SNF Jan 15, 2016

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

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.

Affiliated clinicians 1

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": "1127088000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1369958400000",
    "number": "1891780516",
    "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": "152 5TH ST S",
            "city": "GREENBUSH",
            "state": "MN",
            "postal_code": "567264406",
            "telephone_number": "218-782-2131",
            "fax_number": "218-782-4005"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFECARE MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-09-19",
        "last_updated": "2013-05-31",
        "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": "346331",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UCARE",
            "identifier": "NH0426",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "850026600",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Greenbush, MN

Sources for this page

Verify at the official NPI Registry.