Black Vine LLC

Primary specialty

Case Management AgencyTaxonomy code 251B00000X

License

348111 Issued in MN

Legal business name

BLACK VINE LLC

Doing business as

ComForcare Senior Services

Practice address

4445 W 77TH St
Suite 122
Edina, MN 55435-5133

Phone

(952) 960-2266

Fax

(952) 960-2267

NPI assigned

Jun 25, 2010

Organization subpart

No

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

Authorized official

Name

Mr. Sam A Mitchell

Title

Owner

Phone

(952) 960-2266

Specialties & licenses 1

Addresses

Other names 1

• ComForcare Senior Services Doing business as

Locations

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

{
    "created_epoch": "1277424000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1277424000000",
    "number": "1326359159",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4445 W 77TH ST",
            "address_2": "SUITE 122",
            "city": "EDINA",
            "state": "MN",
            "postal_code": "554355133",
            "telephone_number": "952-960-2266",
            "fax_number": "952-960-2267"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4445 W 77TH ST",
            "address_2": "SUITE 122",
            "city": "EDINA",
            "state": "MN",
            "postal_code": "554355133",
            "telephone_number": "952-960-2266",
            "fax_number": "952-960-2267"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLACK VINE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-06-25",
        "last_updated": "2010-06-25",
        "status": "A",
        "authorized_official_last_name": "MITCHELL",
        "authorized_official_first_name": "SAM",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "952-960-2266",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "251B00000X",
            "taxonomy_group": "",
            "desc": "Case Management",
            "state": "MN",
            "license": "348111",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ComForcare Senior Services",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Kathryn Nicole Bjelland, PA-C
• Brian Peter Bjerke, M.D.
• Emma Bjorgaard, MSW, LGSW
• Allison Bjork
• James Allan Bjostad
• Erin Elizabeth Blackwell, APRN
• Blair Blanchette, DNP
• Vanessa Blaney, PT, DPT
• BLC-Edina Park Plaza, LLC (Brookdale Edina)
• Christine Ann Morrison Bliven, MD

• Case Management Agency in Edina, MN
• Providers in Edina, MN by specialty
• Case Management Agency in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 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.