NPIMap

Organization Active NPI

Fond Du Lac Reservation Business Committee

  • Assisted Living Facility
  • Cloquet, MN
National Provider Identifier
1134426778
Registry record updated Mar 22, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Assisted Living FacilityTaxonomy code 310400000X
License
349645 Issued in MN
Legal business name
FOND DU LAC RESERVATION BUSINESS COMMITTEE
Practice address
1571 Airport Road
Fond Du Lac Assisted Living
Cloquet, MN 55720
Phone
(218) 879-1227
Fax
(218) 878-3755
NPI assigned
Feb 17, 2011
Organization subpart
Yes
Parent organization
FOND DU LAC HUMAN SERVICES DIVISIONAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 22, 2016

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

Authorized official

Name
Mrs. Marilyn Grover
Title
Associate Director
Phone
(218) 879-1227

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Assisted Living Facility 310400000X 349645 MN Primary
Assisted Living Facility 310400000X 348710 MN
Assisted Living Facility 310400000X 25541M MN

Addresses

Primary practice location

1571 Airport Road
Fond Du Lac Assisted Living
Cloquet, MN 55720

Mailing address

927 Trettel Lane
Fond Du Lac Human Services Division
Cloquet, MN 55720
Phone (218) 879-1227

Other names 1

  • Fond du Lac Assisted Living Doing business as

National Provider Directory

National Provider Directory
Tax ID family
FDL Adolescent Outpatient TX8 organizations share this tax ID, including this one
Part of
FDL Adolescent Outpatient TX

Other organizations with this tax ID 7

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

Locations

1571 Airport Rd
Cloquet, MN 55720
Phone (218) 879-1227

NPI Registry JSON

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

{
    "created_epoch": "1297900800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1458604800000",
    "number": "1134426778",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "927 TRETTEL LANE",
            "address_2": "FOND DU LAC HUMAN SERVICES DIVISION",
            "city": "CLOQUET",
            "state": "MN",
            "postal_code": "55720",
            "telephone_number": "218-879-1227",
            "fax_number": "218-878-3755"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1571 AIRPORT ROAD",
            "address_2": "FOND DU LAC ASSISTED LIVING",
            "city": "CLOQUET",
            "state": "MN",
            "postal_code": "55720",
            "telephone_number": "218-879-1227",
            "fax_number": "218-878-3755"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FOND DU LAC RESERVATION BUSINESS COMMITTEE",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "FOND DU LAC HUMAN SERVICES DIVISION",
        "enumeration_date": "2011-02-17",
        "last_updated": "2016-03-22",
        "status": "A",
        "authorized_official_last_name": "GROVER",
        "authorized_official_first_name": "MARILYN",
        "authorized_official_title_or_position": "ASSOCIATE DIRECTOR",
        "authorized_official_telephone_number": "218-879-1227",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "MN",
            "license": "349645",
            "primary": true
        },
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "MN",
            "license": "348710",
            "primary": false
        },
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "MN",
            "license": "25541M",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Fond du Lac Assisted Living",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Cloquet, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 22, 2016; 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.