WENDIGO PINES ASSISTED LIVING (NPI# 1205913613) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1205913613 |
| Entity Type | Organization |
| Organization Name | WENDIGO PINES ASSISTED LIVING |
| Practice Address |
20371 Wendigo Park Rd Grand Rapids MN 55744 |
| Practice Telephone | 2183266900 |
| Practice Fax Number | 2183266900 |
| Mailing Telephone | 2183266900 |
| Mailing Fax Number | 2183266900 |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | RAISA POVLOVNA KOTULA (RN OWNER) |
| Authorized Official Telephone | 2183266900 |
| Authorized Official Credential | RN |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 310400000X | Assisted Living Facility | 333801 | MN | Nursing & Custodial Care Facilities |
| Street Address |
20371 WENDIGO PARK RD |
| City | GRAND RAPIDS |
| State | MN |
| Zip Code | 55744 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1306185681 | New Journey Residence, Ltd | Assisted Living Facility | 20371 Wendigo Park Rd, Grand Rapids, MN 55744-4675 | 2013-02-07 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1710587696 | Friesen & Friesen, Inc | Assisted Living Facility | 1971 Ne 1st Avenue, Grand Rapids, MN 55744 | 2020-10-29 |
| 1699392555 | Duane Stanley Helmer | Counselor | First Call for Help of Itasca County, 1707 Nw 4th Street Suite B, Grand Rapids, MN 55744 | 2020-06-26 |
| 1821631391 | Patrice Marie Curtiss | Technician | 23792 Winckler Road, Grand Rapids, MN 55744 | 2019-10-28 |
| 1578117438 | Christina Marie Hubred | Advanced Practice Dental Therapist | Miskovich Dental Clinic, 1121 Se 4th Avenue, Grand Rapids, MN 55744 | 2019-07-30 |
| 1780081877 | Fcsl Grand Rapids, LLC | Assisted Living Facility | 949 1/2 Sw 11th Street, Grand Rapids, MN 55744 | 2014-12-04 |
| 1912311333 | Doctor V LLC | Psychologist | 2002 Cromell Drive, Hope House of Itasca County, Laprairie, MN 55744 | 2014-06-13 |
| 1104244987 | Linda Reinen-thompson | Contractor | 34307 Hwy. 38, Grand Rapids, MN 55744 | 2014-03-31 |
| 1275883266 | Lana Rae Jacobson | Registered Nurse | 1401 Nw 9th Street, Grand Rapids, MN 55744 | 2012-09-17 |
| 1518252048 | David Allen Griggs | Pharmacist | 2140 S.pokegama Ave., T-0904, Target, Grand Rapids, MN 55744 | 2011-06-13 |
| 1447575063 | Kelly Ann Shermoen | Pharmacist | 18 Se 10th Street, Grand Rapids, MN 55744 | 2010-04-07 |
| Find all providers in zip 55744 | ||||
| Taxonomy Code | 310400000X |
| Grouping | Nursing & Custodial Care Facilities |
| Classification | Assisted Living Facility |
| 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. |
| Notes: [7/1/2003: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1710587696 | Friesen & Friesen, Inc | Assisted Living Facility | 1971 Ne 1st Avenue, Grand Rapids, MN 55744 | 2020-10-29 |
| 1285290197 | The Emeralds At Grand Rapids Assisted Living LLC | Assisted Living Facility | 2815 S Highway 169, Grand Rapids, MN 55744-9532 | 2019-05-15 |
| 1023587227 | Northwoods Villa Inc. 2 | Assisted Living Facility | 1200 Gunn Rd, Grand Rapids, MN 55744-9212 | 2018-11-16 |
| 1588176432 | Brookstone Manor, Inc. | Assisted Living Facility | 722 N Pokegama Ave, Grand Rapids, MN 55744-2669 | 2017-11-01 |
| 1144769506 | Resolute Adult Living Facility | Assisted Living Facility | 1414 Eastern Ave Se, Grand Rapids, MI 49507-2024 | 2017-02-18 |
| 1548667694 | Fcsl Grand Rapids, LLC | Assisted Living Facility | 949 Sw 11th Ave, Grand Rapids, MN 55744-3562 | 2014-12-04 |
| 1780081877 | Fcsl Grand Rapids, LLC | Assisted Living Facility | 949 1/2 Sw 11th Street, Grand Rapids, MN 55744 | 2014-12-04 |
| 1720350341 | Christian Rest Home Association | Assisted Living Facility | 1010 Edison Ave Nw, Grand Rapids, MI 49504-3918 | 2012-01-27 |
| 1396016796 | Northview Care Corp. | Assisted Living Facility | 3740 Richton Ave Ne, Grand Rapids, MI 49525-2463 | 2012-01-18 |
| 1629238878 | Samaritas | Assisted Living Facility | 1900 32nd St Se, Grand Rapids, MI 49508-7908 | 2008-06-11 |
| Find all providers in GRAND RAPIDS | ||||
| City | GRAND RAPIDS |
| Zip Code | 55744 |
Please comment or provide details below to improve the information on WENDIGO PINES ASSISTED LIVING.
| 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.