Peterson Colonial Homes, Inc.

Primary specialty

Assisted Living Facility (Mental Illness)Taxonomy code 3104A0625X

License

0021 Issued in MN

Legal business name

PETERSON COLONIAL HOMES, INC.

Practice address

4723 Nygaard Road
Brookston, MN 55711-0350

Phone

(218) 878-0642

Fax

(218) 878-2978

NPI assigned

May 24, 2007

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Duane Melvin Schraw

Title

Administrator

Phone

(218) 878-0642

Specialties & licenses 1

Addresses

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

CLIA laboratory certificates

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

{
    "created_epoch": "1179964800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1104037985",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 350",
            "city": "BROOKSTON",
            "state": "MN",
            "postal_code": "557110350",
            "telephone_number": "218-878-0642",
            "fax_number": "218-878-2978"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4723 NYGAARD ROAD",
            "city": "BROOKSTON",
            "state": "MN",
            "postal_code": "557110350",
            "telephone_number": "218-878-0642",
            "fax_number": "218-878-2978"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PETERSON COLONIAL HOMES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-24",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "SCHRAW",
        "authorized_official_first_name": "DUANE",
        "authorized_official_middle_name": "MELVIN",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "218-878-0642"
    },
    "taxonomies": [
        {
            "code": "3104A0625X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility, Assisted Living, Mental Illness",
            "state": "MN",
            "license": "0021",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Assisted Living Facility (Mental Illness) in Brookston, MN
• Providers in Brookston, MN by specialty
• Assisted Living Facility (Mental Illness) in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.