Tamernic

Primary specialty

Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityTaxonomy code 320900000X

Legal business name

TAMERNIC

Practice address

270 W Milkiway Ave
Lake Lillian, MN 56253

Phone

(763) 607-1120

NPI assigned

Jun 8, 2022

Last updated

Aug 19, 2022By 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

Nicholas Jeryl Goedel

Title

Ceo

Phone

(763) 607-1120

Specialties & licenses 3

Addresses

Other identifiers 2

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

{
    "created_epoch": "1654646400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1660867200000",
    "number": "1376272088",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "270 W MILKIWAY AVE",
            "city": "LAKE LILLIAN",
            "state": "MN",
            "postal_code": "56253"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "270 W MILKIWAY AVE",
            "city": "LAKE LILLIAN",
            "state": "MN",
            "postal_code": "56253",
            "telephone_number": "763-607-1120"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TAMERNIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-06-08",
        "last_updated": "2022-08-19",
        "certification_date": "2022-08-16",
        "status": "A",
        "authorized_official_last_name": "GOEDEL",
        "authorized_official_first_name": "NICHOLAS",
        "authorized_official_middle_name": "JERYL",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "763-607-1120"
    },
    "taxonomies": [
        {
            "code": "320700000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Physical Disabilities",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "320800000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Mental Illness",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ADULT FOSTER CARE LICENSE",
            "identifier": "1112662",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "245D LICENSE",
            "identifier": "1110595",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• City of Lake Lillian (Lake Lillian Ambulance Service)
• HGS Innovations (Lillian Ridge)

• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Lake Lillian, MN
• Providers in Lake Lillian, MN by specialty
• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 19, 2022; 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.