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Recently Updated NPI Information — some details in this NPI profile have been updated in the NPI registry within the last 60 days.

AUGUSTANA MERCY CARE CENTER LLC
NPI 1104143791
Assisted Living Facility in Moose Lake, MN

Active since April 23, 2010CLIA 24D2008435 · Waiver
710 S KENWOOD AVE, MOOSE LAKE, MN 55767(218) 485-4481 Get Directions Write a Review

NPPES record last updated: July 23, 2026. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Jul 23, 2026, Nov 21, 2025, Mar 3, 2025 and 1 more (4 updates tracked since 2019).

About Augustana Mercy Care Center Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

AUGUSTANA MERCY CARE CENTER LLC (NPI 1104143791), doing business as Augustana Kenwood Place, is a healthcare organization registered as an assisted living facility in Moose Lake, Minnesota and active in the NPI registry since April 2010. The organization holds a CLIA Waiver certificate valid through June 9, 2028 and lists Seelochani Stadtherr, Avp, Revenue Cycle Management, as its authorized official.

NPPES Registry Identity

NPI1104143791
Entity TypeOrganization
Primary Taxonomy310400000X
Legal Business NameAUGUSTANA MERCY CARE CENTER LLC
Location Address710 S KENWOOD AVEMoose Lake, MN 55767-9405
Mailing Address7171 Ohms LnEdina, MN 55439-2142 · (952) 855-5041
Phone(218) 485-4481
Organization SubpartNo
Authorized OfficialSeelochani StadtherrAvp, Revenue Cycle Management · (952) 855-5041
Enumeration DateApril 23, 2010
Last NPPES UpdateJuly 23, 20264 updates tracked since enumeration
NPPES CertifiedJuly 23, 2026
✔ NPI 1104143791 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyAssisted Living FacilityNursing & Custodial Care Facilities
Taxonomy Code310400000X
Definition
A facility providing supportive services to individuals who can function independently in most areas of activity, but need assistance and/or monitoring to assure safety and well being.
710 S KENWOOD AVE, Moose Lake, MN 55767
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Other Names 2

Doing Business AsAugustana Kenwood Place
Doing Business AsMoose Lake Village Assisted Living - Kenwood

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 24D2008435

Augustana Mercy Care Center · Moose Lake, MN
Active · expires Jun 9, 2028
CLIA Number24D2008435
Laboratory TypeSkilled Nursing Facility/Nursing Facility
Certificate Effective DateJune 10, 2026
Certificate Expiration DateJune 9, 2028
Laboratory DirectorAshley Bachman
Laboratory Phone(218) 485-4481
Laboratory LocationAugustana Mercy Care Center710 South Kenwood Avenue, Moose Lake, MN 55767
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 11

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MOOSE LAKE COMMUNITY HOSPITAL DISTRICT
Skilled Nursing Facility
710 S KENWOOD AVE
MOOSE LAKE, MN 55767
Carlton County (218) 485-4481
LORI ANN ZIEHL OTR
Occupational Therapist
710 S KENWOOD AVE
MOOSE LAKE, MN 55767
Carlton County (218) 485-5522
RONALD WILLIAM NEVA PT
Physical Therapist
710 S KENWOOD AVE
MOOSE LAKE, MN 55767
Carlton County (218) 485-5516
MOOSE LAKE COMMUNITY HOSPITAL DISTRICT
General Acute Care Hospital (Critical Access)
710 S KENWOOD AVE
MOOSE LAKE, MN 55767
Carlton County (218) 485-4481
DR. ARUN J SHANKAR M.D.
Emergency Medicine
710 S KENWOOD AVE
MOOSE LAKE, MN 55767
Carlton County (218) 485-5541
MRS. LUANN JOYCE CHARBONEAU PT
Physical Therapist
710 S KENWOOD AVE
MOOSE LAKE, MN 55767
Carlton County (218) 485-5627
AUGUSTANA MERCY CARE CENTER LLC
Skilled Nursing Facility
710 S KENWOOD AVE
MOOSE LAKE, MN 55767
Carlton County (218) 485-4481
JEFFREY ALLEN SCHNEIDER CRNA
Nurse Anesthetist, Certified Registered
710 S KENWOOD AVE
MOOSE LAKE, MN 55767
Carlton County (218) 485-4481

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Augustana Mercy Care Center LLC's NPI number?

The NPI number for Augustana Mercy Care Center LLC is 1104143791. It was assigned to this organization in the NPPES registry on April 23, 2010. The provider is doing business as Augustana Kenwood Place and Moose Lake Village Assisted Living - Kenwood.

Where is Augustana Mercy Care Center LLC located?

Augustana Mercy Care Center LLC is located at 710 S Kenwood Ave, Moose Lake, MN 55767. The listed phone number is (218) 485-4481.

What is Augustana Mercy Care Center LLC's specialty?

The primary specialty registered for this NPI is Assisted Living Facility with taxonomy code 310400000X.

Does Augustana Mercy Care Center LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 24D2008435) is associated with this NPI, valid through June 9, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Augustana Mercy Care Center LLC was last updated on July 23, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 17 days ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.