NPIMap

Organization Active NPI

Memory Care Clinic

  • Clinic/Center
  • Saint Cloud, MN
National Provider Identifier
1205940863
Registry record updated Oct 19, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
License
1200898-2 Issued in MN
Legal business name
MEMORY CARE CLINIC
Practice address
2835 W Saint Germain St
Saint Cloud, MN 56301-6280
Phone
(320) 257-1777
Fax
(320) 257-1776
NPI assigned
Aug 19, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 19, 2009

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

Authorized official

Name
Sandra L. Wenner
Title
Executive Director
Phone
(320) 257-1777

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X 1200898-2 MN Primary

Addresses

Primary practice location

2835 W Saint Germain St
Saint Cloud, MN 56301-6280

Mailing address

2835 W Saint Germain St
P.O. Box 7776
Saint Cloud, MN 56301-6280
Phone (320) 257-1777

Other identifiers 2

IdentifierTypeStateIssuer
CO4052OtherMNMEDICARE PROVIDER GROUP NUMBER
567188400MedicaidMN

National Provider Directory

National Provider Directory

Locations

2835 W Saint Germain St
Ste 300
Saint Cloud, MN 56301
Phone (320) 257-1777

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1155945600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1255910400000",
    "number": "1205940863",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2835 W SAINT GERMAIN ST",
            "address_2": "P.O. BOX 7776",
            "city": "SAINT CLOUD",
            "state": "MN",
            "postal_code": "563016280",
            "telephone_number": "320-257-1777",
            "fax_number": "320-257-1776"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2835 W SAINT GERMAIN ST",
            "city": "SAINT CLOUD",
            "state": "MN",
            "postal_code": "563016280",
            "telephone_number": "320-257-1777",
            "fax_number": "320-257-1776"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEMORY CARE CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-19",
        "last_updated": "2009-10-19",
        "status": "A",
        "authorized_official_last_name": "WENNER",
        "authorized_official_first_name": "SANDRA",
        "authorized_official_middle_name": "L.",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "320-257-1777"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "MN",
            "license": "1200898-2",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PROVIDER GROUP NUMBER",
            "identifier": "CO4052",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "567188400",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Cloud, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 19, 2009; 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.