Northern Lights Athlete Village

Primary specialty

Case Management AgencyTaxonomy code 251B00000X

License

1411 Issued in MN

Legal business name

NORTHERN LIGHTS ATHLETE VILLAGE

Practice address

8109 Bryant Ave S
Bloomington, MN 55420-5711

Phone

(952) 888-4311

NPI assigned

Dec 20, 2007

Organization subpart

No

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

Authorized official

Name

Mrs. Stephanie Smith, ATC

Title

Ceo

Phone

(952) 888-4311

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1198108800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1198108800000",
    "number": "1376727735",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8109 BRYANT AVE S",
            "city": "BLOOMINGTON",
            "state": "MN",
            "postal_code": "554205711",
            "telephone_number": "952-888-4311"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8109 BRYANT AVE S",
            "city": "BLOOMINGTON",
            "state": "MN",
            "postal_code": "554205711",
            "telephone_number": "952-888-4311"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHERN LIGHTS ATHLETE VILLAGE",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-12-20",
        "last_updated": "2007-12-20",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "STEPHANIE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "952-888-4311",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "ATC"
    },
    "taxonomies": [
        {
            "code": "251B00000X",
            "taxonomy_group": "",
            "desc": "Case Management",
            "state": "MN",
            "license": "1411",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Case Management Agency in Bloomington, MN
• Providers in Bloomington, 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 Dec 20, 2007; 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.