St. David's Center

Primary specialty

Rehabilitation Clinic/CenterTaxonomy code 261QR0400X

Legal business name

ST. DAVID'S CENTER

Practice address

3395 Plymouth Rd
Minnetonka, MN 55305-3765

Phone

(952) 939-0396

NPI assigned

May 22, 2007

Organization subpart

No

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

Authorized official

Name

Julie Sjordal

Title

Ceo

Phone

(952) 939-0396

Specialties & licenses 6

Addresses

Other identifiers 1

Other names 1

• St. David's Center for Child & Family Development Former legal business name

Medicare fee-for-service enrollment

Enrolled in MN

Enrollment records 1

Outpatient physical therapy / speech pathology certification: CCN 246566

Legal name

ST DAVIDS CHILD DEV & FAMILY SRVS

Certification status

Active

Provider type (POS)

Outpatient physical therapy / speech pathology

Participating since

Nov 22, 1994

Last certification

May 10, 2017

Ownership / control type

Voluntary Non-Profit Other Than Church

Facility address

3395 Plymouth Road
Minnetonka, MN 55305

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

• St. David's Center

  dba St. David's Center for Child & Family Development

  • Community/Behavioral Health Agency
  • Minnetonka, MN
  • NPI 1487816468

  O20140617000717

  Same enrollment

Tax ID family

MN St Davids Center2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

• St. David's Center

  dba St. David's Center for Child & Family Development

  • Case Management Agency
  • Minnetonka, MN
  • NPI 1851553838
  NPD tax ID

Locations

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Madelyn Hudlow, OTD, OTR/L

  • Occupational Therapist
  • Minneapolis, MN
  • NPI 1699666370
  Medicare reassignment NPD
• Brianna Elizabeth Hoyt, OTR/L

  • Occupational Therapist
  • South Bend, IN
  • NPI 1639862113

  MN

  Medicare reassignment NPD
• Bemnet Zewde Habtamu

  • Occupational Therapist
  • Minneapolis, MN
  • NPI 1154272193
  Medicare reassignment
• Haven Schultze, SLP-CCC

  • Speech-Language Pathologist
  • Minneapolis, MN
  • NPI 1518837756
  Medicare reassignment
• Joan M. Trieff, OTR/L

  • Occupational Therapist
  • Minnetonka, MN
  • NPI 1679070783
  Medicare reassignment

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

{
    "created_epoch": "1179792000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1649289600000",
    "number": "1376752337",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3395 PLYMOUTH RD",
            "city": "MINNETONKA",
            "state": "MN",
            "postal_code": "553053765"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3395 PLYMOUTH RD",
            "city": "MINNETONKA",
            "state": "MN",
            "postal_code": "553053765",
            "telephone_number": "952-939-0396"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1200 Marquette Ave",
            "address_purpose": "LOCATION",
            "city": "Minneapolis",
            "state": "MN",
            "postal_code": "554032419",
            "country_code": "US",
            "telephone_number": "952-939-0396",
            "fax_number": "952-548-8760",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "ST. DAVID'S CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-22",
        "last_updated": "2022-04-07",
        "certification_date": "2022-04-07",
        "status": "A",
        "authorized_official_last_name": "SJORDAL",
        "authorized_official_first_name": "JULIE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "952-939-0396"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor, Mental Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225X00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Occupational Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QH0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Hearing and Speech",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "374U00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Home Health Aide",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "426345600",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "St. David's Center for Child & Family Development",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "St. David's Center for Child & Family Development",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• Danielle Spizzirri
• Cindy Lou Sprau, CNP
• Brett Robert Springsted, PMHNP-BC
• Mary Elizabeth Spurlock, APRN
• St John Home Care
• St. David's Center (St. David's Center for Child & Family Development)
• St. David's Center
• St. David's Center (St. David's Center for Child & Family Development)
• Stephanie Stackhouse, M.D.
• Stacy Vancura Counseling

• Rehabilitation Clinic/Center in Minnetonka, MN
• Providers in Minnetonka, MN by specialty
• Rehabilitation Clinic/Center in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 7, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.