KTJ 292, LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

Legal business name

KTJ 292, LLC

Practice address

22 Malcolm Ave SE
Minneapolis, MN 55414-7584

Phone

(612) 723-7000

NPI assigned

Apr 30, 2020

Organization subpart

No

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

Authorized official

Name

Rebecca Bollig

Title

Executive Director

Phone

(612) 623-7000

Specialties & licenses 1

Addresses

Other names 1

• Pillars of Prospect Park Doing business as

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

{
    "created_epoch": "1588204800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1588204800000",
    "number": "1275154262",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "22 MALCOLM AVE SE",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554147584",
            "telephone_number": "612-723-7000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22 MALCOLM AVE SE",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554147584",
            "telephone_number": "612-723-7000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KTJ 292, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-04-30",
        "last_updated": "2020-04-30",
        "certification_date": "2020-04-30",
        "status": "A",
        "authorized_official_last_name": "BOLLIG",
        "authorized_official_first_name": "REBECCA",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "612-623-7000"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pillars of Prospect Park",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Steven Wenzel Kryzer
• Jennifer Ann Tam Krzmarzick, MD
• Cathie L Krzywon
• Ksa Psychological Services, LLC
• Vibhu R Kshettry, MD
• Christina Ku, PHARMD
• Mary Kuan
• Tina M Kubat, CRNA
• Afanwi Lumsina Kube, CNP
• Julie Kuberski, OTR/L

• Assisted Living Facility in Minneapolis, MN
• Providers in Minneapolis, 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 Apr 30, 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.