PETERSON COLONIAL HOMES, INC. (NPI# 1104037985) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1104037985 |
| Entity Type | Organization |
| Organization Name | PETERSON COLONIAL HOMES, INC. |
| Practice Address |
4723 Nygaard Road Brookston MN 55711-0350 |
| Mailing Address |
Po Box 350 Brookston MN 55711-0350 |
| Practice Telephone | 2188780642 |
| Practice Fax Number | 2188782978 |
| Mailing Telephone | 2188780642 |
| Mailing Fax Number | 2188782978 |
| Enumeration Date | 2007-05-24 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | DUANE MELVIN SCHRAW (ADMINISTRATOR) |
| Authorized Official Telephone | 2188780642 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 3104A0625X |
Assisted Living Facility Specialization: Assisted Living, Mental Illness |
0021 | MN | Nursing & Custodial Care Facilities |
| Street Address |
4723 NYGAARD ROAD |
| City | BROOKSTON |
| State | MN |
| Zip Code | 55711-0350 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1285073783 | Brooke Manor Inc | Assisted Living Facility | 4878 Hwy 31, Brookston, MN 55711 | 2013-06-18 |
| 1255683660 | Ajbb Duluth Properties | Custodial Care Facility | 5130 Hwy. 31, Brookston, MN 55711 | 2012-10-09 |
| 1699008805 | Sharon Shofner Adult Foster Care | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 8783 2nd St South, Brookston, MN 55711 | 2009-09-08 |
| 1790060838 | Stonehaven Assisted Living Inc. | Nursing Facility/Intermediate Care Facility | 8783 2nd Street South, Brookston, MN 55711-0284 | 2011-10-20 |
| 1124349790 | Andrew Timothy Shofner | Case Manager/Care Coordinator | 4849 4th Ave, Brookston, MN 55711-0317 | 2010-06-18 |
| 1942586532 | Jennier Renee Johnson | Assisted Living Facility | 8783 2nd Street South, Brookston, MN 55711-0367 | 2011-10-26 |
| 1891944120 | Transitions Plus, Inc. | Foster Care Agency | 9316 Mccamus Rd, Brookston, MN 55711-8050 | 2008-09-10 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952908667 | Cassandra Nicole Snell | Registered Nurse | 5258 Farm Road 1506, Brookston, TX 75421-4318 | 2020-10-06 |
| 1902410772 | Ashley Kathleen Rosenbarger | Registered Nurse | 8362 S 125 E, Brookston, IN 47923-8238 | 2020-08-31 |
| 1790202075 | Mackenzie K. Lopp | Dentist | 803 S Prairie St, Brookston, IN 47923-8410 | 2017-08-28 |
| 1285073783 | Brooke Manor Inc | Assisted Living Facility | 4878 Hwy 31, Brookston, MN 55711 | 2013-06-18 |
| 1255683660 | Ajbb Duluth Properties | Custodial Care Facility | 5130 Hwy. 31, Brookston, MN 55711 | 2012-10-09 |
| 1750648762 | Tammy Louise Taylor-walden | Physical Therapist | 10281 S Wildwood Ct, Brookston, IN 47923-8357 | 2012-04-13 |
| 1790060838 | Stonehaven Assisted Living Inc. | Nursing Facility/Intermediate Care Facility | 8783 2nd Street South, Brookston, MN 55711-0284 | 2011-10-20 |
| 1003106022 | Lizabeth Lee Marks-shepard | Pharmacist | 11030 S 200 W, Brookston, IN 47923-8217 | 2011-04-11 |
| 1124321484 | Life Essentials LLC | Durable Medical Equipment & Medical Supplies | 8796 S Us Highway 231, Brookston, IN 47923-8018 | 2010-12-08 |
| 1124349790 | Andrew Timothy Shofner | Case Manager/Care Coordinator | 4849 4th Ave, Brookston, MN 55711-0317 | 2010-06-18 |
| Find all providers in BROOKSTON | ||||
| Taxonomy Code | 3104A0625X |
| Grouping | Nursing & Custodial Care Facilities |
| Classification | Assisted Living Facility |
| Specialization | Assisted Living, Mental Illness |
| A facility providing supportive services to individuals who can function independently in most areas of activity, but need special guidance, assistance and/or monitoring as the result of a psychiatric problem. This type of facility requires a staff with special training in mental health training and dealing with psychiatric emergencies. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1699380683 | Gabby Care Homes LLC | Assisted Living Facility | 1513 Pennsylvania Ave N, Champlin, MN 55316-2016 | 2020-09-15 |
| 1982214607 | Parkview Manor Inc | Assisted Living Facility | 5802 Bass Lake Rd, Crystal, MN 55429-2749 | 2020-08-06 |
| 1578171518 | New Horizon Assisted Living LLC | Assisted Living Facility | 5916 71st Ave N, Brooklyn Park, MN 55429-1005 | 2020-07-15 |
| 1720609621 | Home Joy Home Care, Inc. | Assisted Living Facility | 7632 83rd Ave N, Brooklyn Park, MN 55445-2247 | 2020-05-01 |
| 1689211666 | Gabby Care Homes LLC | Assisted Living Facility | 1500 Pennsylvania Ave N, Champlin, MN 55316-2017 | 2019-12-09 |
| 1659871507 | Progressive Home Health Care, Inc. | Assisted Living Facility | 2933 11th Ave S, Minneapolis, MN 55407-1314 | 2018-02-16 |
| 1841651916 | Wellness Homes Inc. | Assisted Living Facility | 214 E 19th St, Apt 301, Minneapolis, MN 55403-3963 | 2016-03-16 |
| 1487995791 | Rose Haven | Assisted Living Facility | 37 6th St Se, Menahga, MN 56464-3157 | 2013-03-12 |
| 1881954964 | Rem Arrowhead, Inc. | Assisted Living Facility | 214 7th St, Cloquet, MN 55720-1805 | 2012-05-22 |
| 1477854289 | Rem Heartland, Inc. | Assisted Living Facility | 1205 Victoria St, Fairmont, MN 56031-4453 | 2010-11-10 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.