West Bloomington Residence

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

334473 Issued in MN

Legal business name

WEST BLOOMINGTON RESIDENCE

Practice address

10441 Johnson Ave S
Minneapolis, MN 55437-2819

Phone

(763) 550-1774

NPI assigned

Mar 16, 2007

Last updated

Apr 25, 2008By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Marcia Sue Dooner

Title

Director

Phone

(763) 550-1774

Specialties & licenses 2

Addresses

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

{
    "created_epoch": "1174003200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1209081600000",
    "number": "1366566572",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10441 JOHNSON AVE S",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554372819",
            "telephone_number": "763-550-1774"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10441 JOHNSON AVE S",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554372819",
            "telephone_number": "763-550-1774"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WEST BLOOMINGTON RESIDENCE",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-16",
        "last_updated": "2008-04-25",
        "status": "A",
        "authorized_official_last_name": "DOONER",
        "authorized_official_first_name": "MARCIA",
        "authorized_official_middle_name": "SUE",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "763-550-1774"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "MN",
            "license": "334473",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• 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 25, 2008; 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.