NPIMap

Organization Active NPI

Acres for Life Therapy & Wellness Center

  • Counselor
  • Chisago City, MN
National Provider Identifier
1053702910
Registry record updated Feb 13, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
CounselorTaxonomy code 101Y00000X
License
302220 Issued in MN
Legal business name
ACRES FOR LIFE THERAPY & WELLNESS CENTER
Practice address
11720 256TH St
Chisago City, MN 55013-9752
Phone
(651) 257-4159
NPI assigned
Feb 13, 2015
Last updated
Feb 13, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 13, 2015

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

Authorized official

Name
Ms. Lynn Marie Moore
Title
Executive Director
Phone
(651) 257-4159

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Counselor 101Y00000X 302220 MN Primary

Addresses

Primary practice location

11720 256TH St
Chisago City, MN 55013-9752

Mailing address

11720 256TH St
Chisago City, MN 55013-9752
Phone (651) 257-4159

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20230724003484 MN Part B Supplier - Clinic/Group Practice 3173983038 Receives reassigned benefits from 9 practitioners
Practice locations: Forest Lake, MN

National Provider Directory

National Provider Directory
Tax ID family
Acres for Life Therapy Wellness Center2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Locations

11720 256th St
Chisago City, MN 55013
Phone (651) 257-4159

Practitioners & affiliated clinicians

Practitioners 11

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1423785600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1423785600000",
    "number": "1053702910",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11720 256TH ST",
            "city": "CHISAGO CITY",
            "state": "MN",
            "postal_code": "550139752",
            "telephone_number": "651-257-4159"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11720 256TH ST",
            "city": "CHISAGO CITY",
            "state": "MN",
            "postal_code": "550139752",
            "telephone_number": "651-257-4159"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ACRES FOR LIFE THERAPY & WELLNESS CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-02-13",
        "last_updated": "2015-02-13",
        "status": "A",
        "authorized_official_last_name": "MOORE",
        "authorized_official_first_name": "LYNN",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "651-257-4159",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "",
            "desc": "Counselor",
            "state": "MN",
            "license": "302220",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chisago City, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 13, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.