NPIMap

Organization Active NPI

Ebenezer Lakes Assisted Living

Doing business as Meadows on Fairview

  • Assisted Living Facility
  • Wyoming, MN
National Provider Identifier
1134441827
Registry record updated Feb 22, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Assisted Living FacilityTaxonomy code 310400000X
License
345526 Issued in MN
Legal business name
EBENEZER LAKES ASSISTED LIVING
Doing business as
Meadows on Fairview
Practice address
25565 Fairview Ave
Wyoming, MN 55092-8053
Phone
(651) 982-6228
Fax
(651) 466-0714
NPI assigned
Feb 22, 2010
Last updated
Feb 22, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 22, 2010

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

Authorized official

Name
Ms. Kari Beth Wilson
Title
Campus Manager
Phone
(651) 982-6228

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Assisted Living Facility 310400000X 345526 MN Primary

Addresses

Primary practice location

25565 Fairview Ave
Wyoming, MN 55092-8053

Mailing address

25565 Fairview Ave
Wyoming, MN 55092-8053
Phone (651) 982-6228

Other names 1

  • Meadows on Fairview Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Ebenezer Lakes Assisted Living2 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.

NPI Registry JSON

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

{
    "created_epoch": "1266796800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1266796800000",
    "number": "1134441827",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "25565 FAIRVIEW AVE",
            "city": "WYOMING",
            "state": "MN",
            "postal_code": "550928053",
            "telephone_number": "651-982-6228",
            "fax_number": "651-466-0714"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25565 FAIRVIEW AVE",
            "city": "WYOMING",
            "state": "MN",
            "postal_code": "550928053",
            "telephone_number": "651-982-6228",
            "fax_number": "651-466-0714"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EBENEZER LAKES ASSISTED LIVING",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-02-22",
        "last_updated": "2010-02-22",
        "status": "A",
        "authorized_official_last_name": "WILSON",
        "authorized_official_first_name": "KARI",
        "authorized_official_middle_name": "BETH",
        "authorized_official_title_or_position": "CAMPUS MANAGER",
        "authorized_official_telephone_number": "651-982-6228",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "MN",
            "license": "345526",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Meadows on Fairview",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Wyoming, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 22, 2010; 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.