Plymouth Senior Housing, LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

357338 Issued in MN

Legal business name

PLYMOUTH SENIOR HOUSING, LLC

Practice address

16205 36TH Ave N
Plymouth, MN 55446-3374

Phone

(763) 383-8888

NPI assigned

Feb 14, 2014

Organization subpart

No

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

Authorized official

Name

Mr. Mark Meyer

Title

Cfo

Phone

(651) 631-6120

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Summerwood of Plymouth Other name

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

{
    "created_epoch": "1392336000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1392336000000",
    "number": "1174947824",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16205 36TH AVE N",
            "city": "PLYMOUTH",
            "state": "MN",
            "postal_code": "554463374",
            "telephone_number": "763-383-8888"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16205 36TH AVE N",
            "city": "PLYMOUTH",
            "state": "MN",
            "postal_code": "554463374",
            "telephone_number": "763-383-8888"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PLYMOUTH SENIOR HOUSING, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-02-14",
        "last_updated": "2014-02-14",
        "status": "A",
        "authorized_official_last_name": "MEYER",
        "authorized_official_first_name": "MARK",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "651-631-6120",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "MN",
            "license": "357338",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UMPI",
            "identifier": "A517413000",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Summerwood of Plymouth",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Plymouth Smiles Dentistry, PC
• Plymouth Station Dental, PA
• Plymouth Vision Center, Inc.
• Samantha Jo Poehling, PA-C
• Sara Poff

• Assisted Living Facility in Plymouth, MN
• Providers in Plymouth, 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 Feb 14, 2014; 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.