NPIMap

Organization Active NPI

Cherrywood Advanced Living, LLC

  • Assisted Living Facility
  • Big Lake, MN
National Provider Identifier
1013280882
Registry record updated Feb 9, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Assisted Living FacilityTaxonomy code 310400000X
License
352583 Issued in MN
Legal business name
CHERRYWOOD ADVANCED LIVING, LLC
Practice address
177 Henry Road
Big Lake, MN 55309
Phone
(320) 257-7445
NPI assigned
Feb 9, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 9, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Wendy Hulsebus
Title
Chief Financial Officer
Phone
(320) 257-7445

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Assisted Living Facility 310400000X 352583 MN Primary

Addresses

Primary practice location

177 Henry Road
Big Lake, MN 55309

Mailing address

1685 4TH Ave N
Sauk Rapids, MN 56379-2708
Phone (320) 257-7445

Other identifiers 1

IdentifierTypeStateIssuer
354110OtherMNHOUSING WITH SERVICES LICENSE

Other names 1

  • Cherrywood of Big Lake 177 Other name

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
24D2044060Cherrywood of Big Lake 177177 Henry Road, Big Lake, MN 55309Certificate of waiverJul 16, 2028

National Provider Directory

National Provider Directory
Tax ID family
Cherrywood Advanced Living LLC10 organizations share this tax ID, including this one

Other organizations with this tax ID 9

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1328745600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1328745600000",
    "number": "1013280882",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1685 4TH AVE N",
            "city": "SAUK RAPIDS",
            "state": "MN",
            "postal_code": "563792708",
            "telephone_number": "320-257-7445"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "177 HENRY ROAD",
            "city": "BIG LAKE",
            "state": "MN",
            "postal_code": "55309",
            "telephone_number": "320-257-7445"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHERRYWOOD ADVANCED LIVING, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-02-09",
        "last_updated": "2012-02-09",
        "status": "A",
        "authorized_official_last_name": "HULSEBUS",
        "authorized_official_first_name": "WENDY",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "320-257-7445"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "MN",
            "license": "352583",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HOUSING WITH SERVICES LICENSE",
            "identifier": "354110",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Cherrywood of Big Lake 177",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Big Lake, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 9, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.