Wildwood Grove

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

335745 Issued in MN

Legal business name

WILDWOOD GROVE

Practice address

410 E Main St
Le Roy, MN 55951-6731

Phone

(507) 324-9515

Fax

(507) 324-5355

NPI assigned

May 22, 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

Gerald A Payne

Title

President of Board

Phone

(507) 324-5260

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": "1179792000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1184833394",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "410 E MAIN ST",
            "city": "LE ROY",
            "state": "MN",
            "postal_code": "559516731",
            "telephone_number": "507-324-9515",
            "fax_number": "507-324-5355"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "410 E MAIN ST",
            "city": "LE ROY",
            "state": "MN",
            "postal_code": "559516731",
            "telephone_number": "507-324-9515",
            "fax_number": "507-324-5355"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WILDWOOD GROVE",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-22",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "PAYNE",
        "authorized_official_first_name": "GERALD",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "PRESIDENT OF BOARD",
        "authorized_official_telephone_number": "507-324-5260"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "MN",
            "license": "335745",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lutheran Social Service of Minnesota
• Off-Grid LLC (Spirits At Rest LLC)
• Robert Dean Plumb, DDS
• Regional Health Services of Howard County (Leroy Medical Clinic)
• Kristie M Schmidt, D.C.

• Assisted Living Facility in Le Roy, MN
• Providers in Le Roy, 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 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.