Pine Grove Leadership Academy

Primary specialty

Local Education Agency (LEA)Taxonomy code 251300000X

Legal business name

PINE GROVE LEADERSHIP ACADEMY

Practice address

63842 Ojibwe Rd
Sandstone, MN 55072-3342

Phone

(320) 384-7598

Fax

(320) 384-7485

NPI assigned

Aug 3, 2010

Last updated

Aug 3, 2010By 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

Ms. Amiliya Zago

Title

Director

Phone

(320) 384-7598

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1280793600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1280793600000",
    "number": "1255645149",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "63842 OJIBWE RD",
            "city": "SANDSTONE",
            "state": "MN",
            "postal_code": "550723342",
            "telephone_number": "320-384-7598",
            "fax_number": "320-384-7485"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "63842 OJIBWE RD",
            "city": "SANDSTONE",
            "state": "MN",
            "postal_code": "550723342",
            "telephone_number": "320-384-7598",
            "fax_number": "320-384-7485"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PINE GROVE LEADERSHIP ACADEMY",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-08-03",
        "last_updated": "2010-08-03",
        "status": "A",
        "authorized_official_last_name": "ZAGO",
        "authorized_official_first_name": "AMILIYA",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "320-384-7598",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "251300000X",
            "taxonomy_group": "",
            "desc": "Local Education Agency (LEA)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kenneth Duane Pearson
• Joleen A Peters, APRN, CNP, PMHNP-BC
• Mark H Petry, M.D.
• Nicole Marie Pexsa
• Pine County Human Services (Pine County Health & Human Services)
• Pine Medical Center
• Pine Medical Center (Essentia Health Emergency Medical Services-Sandstone)
• Pine Medical Center (Essentia Health Sandstone)
• Pine Medical Center (Essentia Health Sandstone)
• Pine Medical Center

• Local Education Agency (LEA) in Sandstone, MN
• Providers in Sandstone, MN by specialty
• Local Education Agency (LEA) in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 3, 2010; 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.