Sherburn Economic Development Authority

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

329269 Issued in MN

Legal business name

SHERBURN ECONOMIC DEVELOPMENT AUTHORITY

Practice address

410 Fox Lake Ave
Sherburn, MN 56171-9605

Phone

(952) 888-2923

NPI assigned

Apr 25, 2006

Organization subpart

No

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

Authorized official

Name

Howie Groff

Title

President

Phone

(952) 888-2923

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Temperance Lake Ridge Doing business as

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

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

{
    "created_epoch": "1145923200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1213747200000",
    "number": "1285690347",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "410 FOX LAKE AVE",
            "city": "SHERBURN",
            "state": "MN",
            "postal_code": "561719605"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "410 FOX LAKE AVE",
            "city": "SHERBURN",
            "state": "MN",
            "postal_code": "561719605",
            "telephone_number": "952-888-2923"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHERBURN ECONOMIC DEVELOPMENT AUTHORITY",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-25",
        "last_updated": "2008-06-18",
        "status": "A",
        "authorized_official_last_name": "GROFF",
        "authorized_official_first_name": "HOWIE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "952-888-2923"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "MN",
            "license": "329269",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "250473100",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HWS",
            "identifier": "329269",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Temperance Lake Ridge",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• City of Sherburn
• Compassionate Nursing Care
• Steven Wayne Larson, D.C.
• Prairie Rehabilitation Services, Inc
• Sherburn Chiropractic

• All providers in Sherburn, MN
• Assisted Living Facility in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 18, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.