AUTUMN GLEN SENIOR LIVING LLC (NPI# 1508221136) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1508221136 |
| Entity Type | Organization |
| Organization Name | AUTUMN GLEN SENIOR LIVING LLC |
| Practice Address |
3715 Coon Rapids Blvd Nw Coon Rapids MN 55433-2777 |
| Practice Telephone | 7637724492 |
| Practice Fax Number | 7637464080 |
| Mailing Telephone | 7637724492 |
| Mailing Fax Number | 7637464080 |
| Enumeration Date | 2015-12-26 |
| Last Update Date | 2015-12-26 |
| Authorized Official Name | KRISTIN NEFF (CHIEF OPERATIONS OFFICER) |
| Authorized Official Telephone | 7632414428 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 310400000X | Assisted Living Facility | 372324 | MN | Nursing & Custodial Care Facilities |
| Street Address |
3715 COON RAPIDS BLVD NW |
| City | COON RAPIDS |
| State | MN |
| Zip Code | 55433-2777 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1104323773 | New Western Manor Company Limited Partnership | Assisted Living Facility | 3715 Coon Rapids Blvd Nw, Coon Rapids, MN 55433 | 2018-04-10 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770134793 | Shelley Karee Peterson | Technician | 10311 Bittersweet St Nw, Coon Rapids, MN 55433 | 2019-09-20 |
| 1578122057 | Courtney Gau | Behavior Technician | Fraser Coon Rapids, 9120 Springbrook Dr. Nw, Coon Rapids, MN 55433 | 2019-06-10 |
| 1992275606 | Maliki Fofee Kamara | Licensed Practical Nurse | 2451 109th Ave Nw Apt. 1, Coon Rapids, MN 55433 | 2018-11-26 |
| 1992284541 | Sarah Vennes | Massage Therapist | 6400 Flying Cloud Dr, Suite 240, Eden Prairie, MN 55433 | 2018-08-13 |
| 1538646609 | Paige Prince | Behavior Technician | Fraser Coon Rapids, 9120 Springbrook Drive Nw, Coon Rapids, MN 55433 | 2018-07-23 |
| 1154828242 | Karin Lea Englund | Dentist | 9145 Springbrook Dr Nw Ste 100, Coon Rapids, MN 55433 | 2018-04-06 |
| 1235642513 | Vista Family Eye Care LLC | Optometrist | 9920 Foley Blvd Nw Ste 120, Coon Rapids, MN 55433 | 2017-11-09 |
| 1538697818 | Mohammed Nmn Ahmed | Internal Medicine | 9055 Spring Brook Drive, Allina Coon Rapids Clinic 9055, Coon Rapids, MN 55433 | 2017-05-31 |
| 1639531353 | Journi LLC | Nurse Practitioner | 277 Coon Rapids Blvd Suite 308, Coon Rapids, MN 55433 | 2016-03-22 |
| 1821457722 | Honorine Boyce | Licensed Practical Nurse | 2743 111th Ave. Nw, Coon Rapids, MN 55433 | 2016-02-19 |
| Find all providers in zip 55433 | ||||
| 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 |
|---|---|---|---|---|
| 1063797215 | Margaret Place Limited Partnership | Assisted Living Facility | 1190 117th Ave Nw, Coon Rapids, MN 55448-2383 | 2011-10-19 |
| 1235414483 | Margaret Place Limited Partnership | Assisted Living Facility | 12009 Eagle St Nw, Coon Rapids, MN 55448-1909 | 2011-10-19 |
| 1902189350 | Margaret Place Limited Partnership | Assisted Living Facility | 11777 Xeon Blvd Nw, Coon Rapids, MN 55448-2060 | 2011-09-22 |
| 1578878773 | Voa Care Centers, Minnesota | Assisted Living Facility | 1770 113th Ln Nw, Coon Rapids, MN 55433-3019 | 2010-08-11 |
| 1720252836 | Select Senior Living of Coon Rapids, LLC | Assisted Living Facility | 11350 Martin St Nw, Coon Rapids, MN 55433-3988 | 2008-04-18 |
| 1558483081 | Voa Care Centers, Minnesota | Assisted Living Facility | 11372 Robinson Dr Nw, Coon Rapids, MN 55433-3776 | 2007-04-04 |
| 1578028585 | The Homestead At Coon Rapids, Inc. | Assisted Living Facility | 11372 Robinson Dr Nw, Coon Rapids, MN 55433-4071 | 2019-02-04 |
| 1104323773 | New Western Manor Company Limited Partnership | Assisted Living Facility | 3715 Coon Rapids Blvd Nw, Coon Rapids, MN 55433 | 2018-04-10 |
| 1710262399 | Margaret Place Limited Partnership | Assisted Living Facility | 1555 118th Ln Nw, Coon Rapids, MN 55448-7579 | 2011-10-14 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1871193417 | Midwest Group Home | Assisted Living Facility | 4232 5th St Ne, Columbia Heights, MN 55421-2860 | 2020-10-30 |
| 1710587696 | Friesen & Friesen, Inc | Assisted Living Facility | 1971 Ne 1st Avenue, Grand Rapids, MN 55744 | 2020-10-29 |
| 1750980603 | Estherra Care LLC | Assisted Living Facility | 1120 Morgan Ave N, Minneapolis, MN 55411-3805 | 2020-10-21 |
| 1679189682 | Daniel Care Homes LLC | Assisted Living Facility | 6809 Perry Ave N, Brooklyn Center, MN 55429-1611 | 2020-09-16 |
| 1326651779 | Secured Health and Homecare Inc | Assisted Living Facility | 4519 104th Ave N, Brooklyn Park, MN 55443-1030 | 2020-08-26 |
| 1811509870 | Aurora Assisted Living LLC | Assisted Living Facility | 115 Magnolia Ave W, Saint Paul, MN 55117-4916 | 2020-08-20 |
| 1003427477 | In My Father's House | Assisted Living Facility | 3096 Snelling Ave N, Roseville, MN 55113-1659 | 2020-08-11 |
| 1710595863 | Eden Prairie Senior Living | Assisted Living Facility | 8480 Franlo Rd, Eden Prairie, MN 55344-2938 | 2020-07-15 |
| 1447868468 | Brightstar Services LLC | Assisted Living Facility | 1821 University Ave W Ste 120, Saint Paul, MN 55104-2811 | 2020-07-15 |
| 1235757667 | Roers Senior Living Buffalo LLC | Assisted Living Facility | 150 Division Street East, Buffalo, MN 55313 | 2020-07-13 |
| Find all providers with the same taxonomy | ||||
| City | COON RAPIDS |
| Zip Code | 55433 |
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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.