Peterson Family Living

Primary specialty

Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityTaxonomy code 320900000X

License

1027767 1 WS Issued in MN

Legal business name

PETERSON FAMILY LIVING

Practice address

12400 Ridgewood Dr NW
Elk River, MN 55330-8221

Phone

(763) 441-8034

Fax

(763) 441-8034

NPI assigned

Apr 12, 2007

Organization subpart

No

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

Authorized official

Name

Mrs. Kathie R Peterson

Title

Residential Coordinator

Phone

(763) 441-8034

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1176336000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1205050333",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12400 RIDGEWOOD DR NW",
            "city": "ELK RIVER",
            "state": "MN",
            "postal_code": "553308221",
            "telephone_number": "763-441-8034",
            "fax_number": "763-441-8034"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12400 RIDGEWOOD DR NW",
            "city": "ELK RIVER",
            "state": "MN",
            "postal_code": "553308221",
            "telephone_number": "763-441-8034",
            "fax_number": "763-441-8034"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PETERSON FAMILY LIVING",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-12",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "PETERSON",
        "authorized_official_first_name": "KATHIE",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "RESIDENTIAL COORDINATOR",
        "authorized_official_telephone_number": "763-441-8034",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "MN",
            "license": "1027767 1 WS",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Peacetree Family Institute LTD
• Carly P Pederson, ATC/R
• Pendo Health Services Inc
• Penneh Issie Home Healthcare
• Rebecca Ann Petersen
• Christopher Lee Peterson
• Sheila Renee Peterson
• Candyce Rose Petron
• James Edward Petters, PT
• Mary Phillips, M.A., L.P.

• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Elk River, MN
• Providers in Elk River, MN by specialty
• Intellectual and/or Developmental Disabilities Community Based Residential Treatment 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.