AUGUSTANA MERCY CARE CENTER LLC
NPI 1104143791
Assisted Living Facility in Moose Lake, MN
NPI Status: Active since April 23, 2010
Contact Information
710 S KENWOOD AVE
MOOSE LAKE, MN
ZIP 55767
Phone: (218) 485-4481
- Organization
- Assisted Living Facility
- CLIA Number: 24D2008435
- CLIA Cert. Type: Skilled Nursing Facility/Nursing Facility
- CLIA Exp. Date: 06-09-2028
About AUGUSTANA MERCY CARE CENTER LLC
This page provides the complete NPI Profile along with additional information for Augustana Mercy Care Center Llc, a provider established in Moose Lake, Minnesota operating as a Assisted Living Facility. The healthcare provider is registered in the NPI registry with number 1104143791 assigned on April 2010. The practitioner's primary taxonomy code is 310400000X. The provider is registered as an organization and their NPI record was last updated one year ago. The provider's
- NPI
- 1104143791
- Provider Legal Name
- AUGUSTANA MERCY CARE CENTER LLC
- Other Organization Name
- Other Name Type
- (6)
- Entity Type
- Organization
- Location Address
- 710 S KENWOOD AVE MOOSE LAKE, MN 55767
- Location Phone
- (218) 485-4481
- Mailing Address
- 710 S KENWOOD AVE MOOSE LAKE, MN 55767
- Mailing Phone
- (218) 485-4481
- Is Sole Proprietor?
- No
- Is Organization Subpart?
- No
- Enumeration Date
- 04-23-2010
- Last Update Date
- 11-21-2025
- Code Navigator
Location Map
Specialty - Primary Taxonomy
The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
- Classification
Assisted Living Facility
- Taxonomy Code
- 310400000X
- Type
- Nursing & Custodial Care Facilities
- License State
- MN
- Taxonomy Description
- 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.
CLIA Information
The Clinical Laboratory Improvement Amendments (CLIA) of 1988 applies to facilities or sites that test human specimens for health assessment or to diagnose, prevent, or treat disease. The CLIA Program sets standards for clinical laboratory testing and issues certificates. The NPI / CLIA crosswalk information for this NPI number is:
- CLIA Number
- 24D2008435
- Facility Type
- Skilled Nursing Facility/Nursing Facility
- Certificate Effective Date
- June 10, 2026
- Certificate Expiration Date
- June 09, 2028
- Laboratory Director
- ASHLEY BACHMAN
- Certificate Type
- Certificate of Waiver
- Certificate Type Description
- This CLIA certificate is issued to Augustana Mercy Care Center Llc to perform only waived tests. CLIA defines waived tests as simple tests with a low risk for an incorrect result. Waived tests include certain tests listed in CLIA regulations, tests cleared by the FDA for home use and tests approved by the FDA for waived status and that meet CLIA waiver criteria.
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NPI NPI Number Validation
How NPI Validation Works
The NPI validation process uses the ISO-standard Luhn algorithm, a mathematical "handshake", to ensure that a provider's 10-digit ID is authentic and free of common typing errors.
To verify the NPI 1104143791, we treat the final digit (1) as the Check Digit—the target answer we need to reach. The process begins by taking the first nine digits and adding a constant value of 24, which accounts for the "80840" prefix required for all U.S. health identifiers. We then double every other digit starting from the right and sum the individual digits of those results together. For this specific NPI, that total comes to 59. The final step is to find the difference between that total and the next multiple of ten (60 - 59 = 1).
Digit-by-digit view
Use the first nine digits for the calculation. Starting from the right, double every other digit. The last digit is the check digit and is not part of the calculation.
Step 1: Double every other digit from the right
Starting with the rightmost digit of the first nine digits, double every other value. If doubling creates a two-digit number, add those digits together.
Step 2: Add all digits plus the NPI constant
Add the transformed values, the unchanged digits, and the constant 24.
Step 3: Find the amount needed to reach the next multiple of 10
The next multiple of ten after 59 is 60. The difference is the calculated check digit.
Other Providers at the Same Location
The following 12 providers are registered at the same or a nearby location.
MOOSE LAKE, MN 55767
MOOSE LAKE, MN 55767
MOOSE LAKE, MN 55767
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1104143791, enumerated as an "organization" on April 23, 2010.
The provider is located at 710 S KENWOOD AVE MOOSE LAKE, MN 55767 and the phone number is (218) 485-4481.
Assisted Living Facility with taxonomy code 310400000X.
