Henry Hagen Residence

Primary specialty

Intellectual Disabilities Intermediate Care FacilityTaxonomy code 315P00000X

License

01091 Issued in MN

Legal business name

HENRY HAGEN RESIDENCE

Practice address

19845 Lillehei Ave
Hastings, MN 55033-9354

Phone

(651) 437-9363

Fax

(651) 437-9363

NPI assigned

Jan 14, 2008

Organization subpart

No

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

Authorized official

Name

Roger David Reynolds

Title

Owner

Phone

(651) 603-8881

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1200268800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1200268800000",
    "number": "1194901751",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19845 LILLEHEI AVE",
            "city": "HASTINGS",
            "state": "MN",
            "postal_code": "550339354",
            "telephone_number": "651-437-9363",
            "fax_number": "651-437-9363"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19845 LILLEHEI AVE",
            "city": "HASTINGS",
            "state": "MN",
            "postal_code": "550339354",
            "telephone_number": "651-437-9363",
            "fax_number": "651-437-9363"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HENRY HAGEN RESIDENCE",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-01-14",
        "last_updated": "2008-01-14",
        "status": "A",
        "authorized_official_last_name": "REYNOLDS",
        "authorized_official_first_name": "ROGER",
        "authorized_official_middle_name": "DAVID",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "651-603-8881"
    },
    "taxonomies": [
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": "MN",
            "license": "01091",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Shiloh Heesch, DC
• Joel H. Hendrickson, M.D.
• Kathleen Mary Henry, L.M.F.T.
• Anne Solvberg Hewitt, LPCC
• Roger Alan Hinkley, PT
• Eric Carl Hoberg, PHARM D
• Sherol L Holck, NP

• Intellectual Disabilities Intermediate Care Facility in Hastings, MN
• Providers in Hastings, MN by specialty
• Intellectual Disabilities Intermediate Care Facility in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 14, 2008; 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.