Evans Park, Inc

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

Legal business name

EVANS PARK, INC

Doing business as

Guardian Angels By The Lake

Practice address

13439 185TH LN NW
Elk River, MN 55330-2713

Phone

(763) 241-7682

NPI assigned

May 15, 2018

Last updated

May 15, 2018By the provider in NPPES

Organization subpart

Yes

Parent organization

EVANS PARK, INC.As reported in NPPES

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

Authorized official

Name

Troy Hanson

Title

VP, Cfo

Phone

(763) 241-4445

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Guardian Angels By The Lake 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

Tax ID family

Evans Park Inc4 organizations share this tax ID, including this one

Part of

Evans Park Inc

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

• Evans Park, Inc

  dba Engel Haus

  • Assisted Living Facility
  • Albertville, MN
  • NPI 1043700073
  NPD tax ID
• Evans Park, Inc

  dba Riverview Landing

  • Assisted Living Facility
  • Otsego, MN
  • NPI 1932722584
  NPD tax ID
• Evans Park, Inc.

  • Homemaker
  • Elk River, MN
  • NPI 1427616952
  NPD tax ID

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

{
    "created_epoch": "1526342400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1526342400000",
    "number": "1346730363",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "508 FREEPORT AVE NW STE A",
            "city": "ELK RIVER",
            "state": "MN",
            "postal_code": "553301874"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13439 185TH LN NW",
            "city": "ELK RIVER",
            "state": "MN",
            "postal_code": "553302713",
            "telephone_number": "763-241-7682"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVANS PARK, INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "EVANS PARK, INC.",
        "enumeration_date": "2018-05-15",
        "last_updated": "2018-05-15",
        "status": "A",
        "authorized_official_last_name": "HANSON",
        "authorized_official_first_name": "TROY",
        "authorized_official_title_or_position": "VP, CFO",
        "authorized_official_telephone_number": "763-241-4445"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MN DEPARTMENT OF HUMAN SERVICES",
            "identifier": "A634929300",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Guardian Angels By The Lake",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Jenny E Enstrom, PA
• Charles Burton Erickson, MD
• Kendra Merrie Erickson
• Marisa Erickson
• Cyan Renae Evanoff
• Evans Park, Inc.
• Brianna Faber
• Amy L Fair, M.D.
• Fairview Clinics (M Health Fairview Clinic - Elk River)
• Fairview Pharmacy Services LLC (Fairview Northland Pharmacy Elk River)

• Assisted Living Facility in Elk River, MN
• Providers in Elk River, 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 May 15, 2018; 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.