NPIMap

Organization Active NPI

Estates at Fridley LLC

  • Skilled Nursing Facility
  • Fridley, MN
National Provider Identifier
1962940437
Registry record updated Feb 5, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Skilled Nursing FacilityTaxonomy code 314000000X
Legal business name
ESTATES AT FRIDLEY LLC
Practice address
5700 E River Rd
Fridley, MN 55432-6149
Phone
(763) 571-3150
NPI assigned
Feb 5, 2017
Last updated
Feb 5, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 5, 2017

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

Authorized official

Name
Joshua Legum
Title
Ceo
Phone
(507) 625-8741

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Skilled Nursing Facility 314000000X NU Primary

Addresses

Primary practice location

5700 E River Rd
Fridley, MN 55432-6149

Mailing address

638 Southbend Ave
Mankato, MN 56001-2168
Phone (507) 625-8741

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20170405000530 MN Part A Provider - Skilled Nursing Facility 2466738547 Practice locations: Fridley, MN

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1962940437. Details of each certification follow.

Skilled nursing facility certification: CCN 245201

Legal name
ESTATES AT FRIDLEY LLC
Certification status
Active
Provider type (POS)
Nursing home – SNF/NF dual certification
Participating since
Apr 1, 1975
Last certification
May 2, 2024
Beds
50
Ownership / control type
Nonprofit Corporation
Organization structure
LLCProprietary
Incorporated
Dec 30, 2016 in MN
Enrollment address
5700 E River Rd
Fridley, MN 55432-6149
Nursing home name
THE ESTATES AT FRIDLEY LLC
Affiliated entity
MONARCH HEALTHCARE MANAGEMENT

Care Compare: Nursing home

Medicare Care Compare
Listed as
The Estates at Fridley LLCCCN 245201 · All quality measures
Overall star rating
2 of 5
Health inspections
2 of 5
Staffing
4 of 5
Quality measures
3 of 5
Type
Medicare and Medicaid
Ownership
Non profit - Corporation
Certified
Apr 1, 1975
Medicare certification status
ActiveFrom the Provider of Services file
Certified beds
5046.4 residents per day on average
Chain
Monarch Healthcare Management45 facilities in the chain
Abuse citation
Cited for abuse (Care Compare abuse icon)

Processed by Care Compare on Aug 1, 2026.

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
24D0719362Estates at Fridley, the5700 East River Road, Fridley, MN 55432Certificate of waiverAug 31, 2026

National Provider Directory

National Provider Directory

Locations

5700 E River Rd
Minneapolis, MN 55432
Phone (763) 571-3150

Ownership & related parties

All disclosed owners & managing parties 9

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

NameRoleSinceShare
Spartan Healthcare LLC Organization, Chicago, IL LLC, For-profit 5% Or Greater Direct Ownership Interest Mar 1, 2017 30%
William Stern Individual 5% Or Greater Direct Ownership Interest Mar 1, 2017 20%
Corporate OfficerCfo Mar 1, 2017 20%
Operational/Managerial Control Mar 1, 2017
Marc Halpert Individual 5% Or Greater Indirect Ownership Interest Mar 1, 2017 30%
Corporate OfficerCoo Mar 1, 2017 30%
Corporate DirectorCoo Mar 1, 2017 30%
Jeffrey Arem Individual 5% Or Greater Direct Ownership Interest Mar 1, 2017 6.66%
Monarch Healthcare Operating IV LLC Organization, Mankato, MN LLC, For-profit Operational/Managerial Control Mar 1, 2017 100%
Joshua Legum Individual 5% Or Greater Indirect Ownership Interest Mar 1, 2017 30%
Corporate OfficerCeo Mar 1, 2017 30%
W-2 Managing EmployeeCeo Mar 1, 2017
Yazoma Holdings, LLC Organization, Skokie, IL LLC, For-profit 5% Or Greater Direct Ownership Interest Mar 1, 2017 30%
Noam Jaffa Individual 5% Or Greater Indirect Ownership Interest Mar 1, 2017 6.68%
Nij LLC Organization, St Louis Park, MN LLC, For-profit 5% Or Greater Direct Ownership Interest Mar 1, 2017 6.68%

Facilities with the same owner 44

Facilities that share an organizational owner with 5% or greater ownership or operational control.

View all 44

Practitioners & affiliated clinicians

Practitioners 2

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": "1486252800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1486252800000",
    "number": "1962940437",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "638 SOUTHBEND AVE",
            "city": "MANKATO",
            "state": "MN",
            "postal_code": "560012168",
            "telephone_number": "507-625-8741"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5700 E RIVER RD",
            "city": "FRIDLEY",
            "state": "MN",
            "postal_code": "554326149",
            "telephone_number": "763-571-3150"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ESTATES AT FRIDLEY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-02-05",
        "last_updated": "2017-02-05",
        "status": "A",
        "authorized_official_last_name": "LEGUM",
        "authorized_official_first_name": "JOSHUA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "507-625-8741"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fridley, MN

Sources for this page

Verify at the official NPI Registry.