NPIMap

Organization Active NPI

Minnesota Senior Living LLC

Doing business as Waterford Manor

  • Assisted Living Facility
  • Brooklyn Park, MN
National Provider Identifier
1356686836
Registry record updated Apr 27, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Assisted Living FacilityTaxonomy code 310400000X
Legal business name
MINNESOTA SENIOR LIVING LLC
Doing business as
Waterford Manor
Practice address
6288 Louisiana CT N
Brooklyn Park, MN 55428-2550
Phone
(763) 537-3382
Fax
(763) 535-2075
NPI assigned
Dec 10, 2012
Last updated
Apr 27, 2017By the provider in NPPES
Organization subpart
Yes
Parent organization
PRESBYTERIAN RETIREMENT COMMUNITIES NORTHWESTAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 27, 2017

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

Authorized official

Name
Mark Mullen
Title
Director of Strategic Partnerships
Phone
(425) 559-6325

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Assisted Living Facility 310400000X Primary

Addresses

Primary practice location

6288 Louisiana CT N
Brooklyn Park, MN 55428-2550

Mailing address

915 118TH Ave SE
110
Bellevue, WA 98005-3819
Phone (425) 559-6301

Other names 1

  • Waterford Manor Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Minnesota Senior Living LLC4 organizations share this tax ID, including this one
Part of
Exter House

Other organizations with this tax ID 3

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

NPI Registry JSON

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

{
    "created_epoch": "1355097600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1493251200000",
    "number": "1356686836",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "915 118TH AVE SE",
            "address_2": "110",
            "city": "BELLEVUE",
            "state": "WA",
            "postal_code": "980053819",
            "telephone_number": "425-559-6301",
            "fax_number": "425-559-6302"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6288 LOUISIANA CT N",
            "city": "BROOKLYN PARK",
            "state": "MN",
            "postal_code": "554282550",
            "telephone_number": "763-537-3382",
            "fax_number": "763-535-2075"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MINNESOTA SENIOR LIVING LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PRESBYTERIAN RETIREMENT COMMUNITIES NORTHWEST",
        "enumeration_date": "2012-12-10",
        "last_updated": "2017-04-27",
        "status": "A",
        "authorized_official_last_name": "MULLEN",
        "authorized_official_first_name": "MARK",
        "authorized_official_title_or_position": "DIRECTOR OF STRATEGIC PARTNERSHIPS",
        "authorized_official_telephone_number": "425-559-6325"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Waterford Manor",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Brooklyn Park, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 27, 2017; 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.