KTJ 212, LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

Legal business name

KTJ 212, LLC

Practice address

6000 Chaska Rd
Excelsior, MN 55331-3173

Phone

(952) 401-7444

NPI assigned

Apr 29, 2019

Organization subpart

No

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

Authorized official

Name

Lisa Miskulin

Title

Executive Director

Phone

(952) 401-7444

Specialties & licenses 1

Addresses

Other names 1

• Shorewood Landing Senior Living Doing business as

Electronic endpoints 1

Interoperability endpoints

• Direct secure messaging: dept-ebenezer-shorewoodlanding@fairview.org

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

{
    "created_epoch": "1556496000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1556496000000",
    "number": "1104480714",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6000 CHASKA RD",
            "city": "EXCELSIOR",
            "state": "MN",
            "postal_code": "553313173",
            "telephone_number": "952-401-7444"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6000 CHASKA RD",
            "city": "EXCELSIOR",
            "state": "MN",
            "postal_code": "553313173",
            "telephone_number": "952-401-7444"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KTJ 212, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-04-29",
        "last_updated": "2019-04-29",
        "status": "A",
        "authorized_official_last_name": "MISKULIN",
        "authorized_official_first_name": "LISA",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "952-401-7444"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "DEPT-EBENEZER-SHOREWOODLANDING@fairview.org",
            "affiliation": "N",
            "address_1": "6000 Chaska Rd",
            "city": "Excelsior",
            "state": "MN",
            "country_code": "US",
            "postal_code": "553313173",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Shorewood Landing Senior Living",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Amy M Kloke, MS, CCC-A
• Knewtson Family Chiropractic PA
• Kelly Melissa Knewtson, DC
• Troy Dale Knewtson, DC
• Kaitlin Marie Knuth
• Aaron Kubal, DC
• Lucy Kurtz Eikevik
• David Holt Lane, MD
• Swarna Erramreddi Latha, M.D
• Ryan Lauritsen

• Assisted Living Facility in Excelsior, MN
• Providers in Excelsior, MN by specialty
• Assisted Living Facility in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 29, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.