Suite Living Hospice Care, LLC

Primary specialty

Community Based Hospice Care AgencyTaxonomy code 251G00000X

Legal business name

SUITE LIVING HOSPICE CARE, LLC

Practice address

1824 Buerkle Rd
White Bear Lake, MN 55110-5245

Phone

(651) 770-2273

NPI assigned

Jan 19, 2022

Last updated

May 31, 2022By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Lisa Diez

Title

Administrator

Phone

(651) 467-7423

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MN

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1942952171. Details of each certification follow.

• CCN 241615 Hospice · Active · Details

Hospice certification: CCN 241615

Legal name

SUITE LIVING HOSPICE CARE, LLC

Certification status

Active

Provider type (POS)

Hospice

Participating since

Feb 20, 2023

Last certification

Feb 1, 2023

Organization structure

LLCProprietary

Incorporated

Jan 18, 2022 in MN

Enrollment address

1824 Buerkle Rd
White Bear Lake, MN 55110-5245

Listed as

Suite Living Hospice, LLCCCN 241615 · All quality measures

Certified

Feb 20, 2023

Medicare certification status

ActiveFrom the Provider of Services file

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

CLIA laboratory certificates

All disclosed owners & managing parties 7

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

Owners & managing parties with NPI records 1

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

• Neal C Buddensiek

  • Internal Medicine Physician
  • White Bear Lake, MN
  • NPI 1487685236

  Contracted Managing Employee

  CMS ownership

Affiliated clinicians 4

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

• Todd H Holm, M.D.

  • Family Medicine Physician
  • Prior Lake, MN
  • NPI 1811971179

  Hospice

  Care Compare affiliation
• Matthew James Logan, MD

  • Family Medicine Physician
  • Stillwater, MN
  • NPI 1033213228

  Hospice

  Care Compare affiliation
• Josephine O'Gara, MD

  • Internal Medicine Physician
  • Stillwater, MN
  • NPI 1124197140

  Hospice

  Care Compare affiliation
• Charles Dennis O'Hare, MD

  • Family Medicine Physician
  • Stillwater, MN
  • NPI 1265474811

  Hospice

  Care Compare affiliation

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

{
    "created_epoch": "1642550400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1653955200000",
    "number": "1942952171",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1824 BUERKLE RD",
            "city": "WHITE BEAR LAKE",
            "state": "MN",
            "postal_code": "551105245",
            "telephone_number": "651-770-2273"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1824 BUERKLE RD",
            "city": "WHITE BEAR LAKE",
            "state": "MN",
            "postal_code": "551105245",
            "telephone_number": "651-770-2273"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUITE LIVING HOSPICE CARE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-01-19",
        "last_updated": "2022-05-31",
        "certification_date": "2022-05-31",
        "status": "A",
        "authorized_official_last_name": "DIEZ",
        "authorized_official_first_name": "LISA",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "651-467-7423"
    },
    "taxonomies": [
        {
            "code": "251G00000X",
            "taxonomy_group": "",
            "desc": "Hospice Care, Community Based",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Michele Marie Stemwedel, MS CCC-SLP
• Erlyn Strelow
• Strength in Nutrition
• Garth William Strobel, DC
• Samantha Stroik
• Leif Per-Alden Sundberg, PA-C
• Margaret E Sundell, M.A., NCTMB
• Sunstone Counseling LLC
• Supervalu Pharmacies Inc (Cub Pharmacy)
• Supervalu Pharmacies Inc (Cub Pharmacy)

• Community Based Hospice Care Agency in White Bear Lake, MN
• Providers in White Bear Lake, MN by specialty
• Community Based Hospice Care Agency in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 31, 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.

Verify at the official NPI Registry.