MINNESOTA SENIOR LIVING LLC (NPI# 1356686836) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1356686836 |
| Entity Type | Organization |
| Organization Name | MINNESOTA SENIOR LIVING LLC |
| Other Organization Name | WATERFORD MANOR |
| Practice Address |
6288 Louisiana Ct N Brooklyn Park MN 55428-2550 |
| Mailing Address |
915 118th Ave Se 110 Bellevue WA 98005-3819 |
| Practice Telephone | 7635373382 |
| Practice Fax Number | 7635352075 |
| Mailing Telephone | 4255596301 |
| Mailing Fax Number | 4255596302 |
| Enumeration Date | 2012-12-10 |
| Last Update Date | 2017-04-27 |
| Authorized Official Name | MARK MULLEN (DIRECTOR OF STRATEGIC PARTNERSHIPS) |
| Authorized Official Telephone | 4255596325 |
| Is Organization Subpart | Y |
| Parent Organization Name | PRESBYTERIAN RETIREMENT COMMUNITIES NORTHWEST |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 310400000X | Assisted Living Facility | Nursing & Custodial Care Facilities |
| Other Name | Type Code |
|---|---|
| Waterford Manor | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1780929257 | Minnesota Senior Living LLC | Assisted Living Facility | 3000 Douglas Dr N, Crystal, MN 55422-2452 | 2012-12-10 |
| 1548505027 | Minnesota Senior Living LLC | Assisted Living Facility | 8500 Tessman Farm Rd N, Brooklyn Park, MN 55445-2297 | 2012-12-10 |
| 1720593353 | Minnesota Senior Living LLC | Assisted Living Facility | 163 Wayzata Blvd W, Wayzata, MN 55391-1562 | 2017-12-05 |
| Street Address |
6288 LOUISIANA CT N |
| City | BROOKLYN PARK |
| State | MN |
| Zip Code | 55428-2550 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1952940025 | Gerard Idrissa Omari | Registered Nurse | 5844 Jersey Avenue North, Crystal, MN 55428 | 2020-01-06 |
| 1538706726 | Mary Sue Wester | Preventive Medicine | 6101 Virginia Ave. N, New Hope, MN 55428 | 2019-12-06 |
| 1194237479 | Stacy Shrestha | Nurse Practitioner | 7100 Northland Circle N, Ste 119, Brooklyn Park, MN 55428 | 2017-10-26 |
| 1023537115 | Cynthia Mcquade-brinkman | Massage Therapist | 6617 Jersey Ave N, Brooklyn Park, MN 55428 | 2017-09-11 |
| 1255792818 | Sadiya Ali | Non-emergency Medical Transport (VAN) | 7164 72nd Lane N Apt 244, Brooklyn Park, MN 55428 | 2016-03-10 |
| 1962867606 | Heart Felt Home Health Care Inc. | Home Health | 36 Fremont St., Lowell, MA 55428 | 2015-12-23 |
| 1992126155 | North Memorial Health Care | Clinic/Center | 8100 42nd Avenue North, New Hope, MN 55428 | 2013-12-13 |
| 1508105370 | Guardian Home Health Care LLC | Home Health | 6708 Dutton Ave N, Brooklyn Park, MN 55428 | 2013-02-13 |
| 1265709182 | Mark David Wermers | Pharmacist | 4200 Winnetka Ave, New Hope, MN 55428 | 2011-11-21 |
| 1841424868 | Cozy Clalm LLC | Durable Medical Equipment & Medical Supplies | 6616 Hillsboro Ave N, Brooklyn Park, MN 55428 | 2009-05-05 |
| Find all providers in zip 55428 | ||||
| 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 |
|---|---|---|---|---|
| 1326651779 | Secured Health and Homecare Inc | Assisted Living Facility | 4519 104th Ave N, Brooklyn Park, MN 55443-1030 | 2020-08-26 |
| 1134740939 | Suite Living Senior Care of Brooklyn Park | Assisted Living Facility | 8500 Regent Ave N, Brooklyn Park, MN 55443-2391 | 2020-05-03 |
| 1730716804 | Kindheart Homes Inc | Assisted Living Facility | 2308 87th Trl N, Brooklyn Park, MN 55443-3732 | 2020-03-26 |
| 1992344402 | Joy Care Homes LLC | Assisted Living Facility | 6825 71st Ave N, Brooklyn Park, MN 55428-1736 | 2019-12-31 |
| 1205474236 | Joy Care Homes LLC | Assisted Living Facility | 4301 78th Ave N, Brooklyn Park, MN 55443-3403 | 2019-12-20 |
| 1265079404 | Phinsaykeo Souriyathay | Assisted Living Facility | 9300 Penn Ave N, Brooklyn Park, MN 55444-1166 | 2019-12-06 |
| 1306493077 | Royal Home Care Inc | Assisted Living Facility | 7832 Penn Ave N, Brooklyn Park, MN 55444-1847 | 2019-08-19 |
| 1932688223 | Bethel Pavilion Homecare LLC | Assisted Living Facility | 3816 83rd Ave N, Brooklyn Park, MN 55443-2753 | 2018-08-08 |
| 1548505027 | Minnesota Senior Living LLC | Assisted Living Facility | 8500 Tessman Farm Rd N, Brooklyn Park, MN 55445-2297 | 2012-12-10 |
| 1487913885 | Empowerment Healthcare, LLC | Assisted Living Facility | 8125 France Ave N, Brooklyn Park, MN 55443-2714 | 2012-05-07 |
| Find all providers in BROOKLYN PARK | ||||
| City | BROOKLYN PARK |
| Zip Code | 55428 |
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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.