NPIMap

Organization Active NPI

Good Shepherd Lutheran Home of Sauk Rapids, MN, Inc.

  • Alzheimer Center (Dementia Center)
  • Sauk Rapids, MN
National Provider Identifier
1396807962
Registry record updated Aug 13, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Alzheimer Center (Dementia Center)Taxonomy code 311500000X
License
333736 Issued in MN
Legal business name
GOOD SHEPHERD LUTHERAN HOME OF SAUK RAPIDS, MN, INC.
Practice address
307 11TH St N
Sauk Rapids, MN 56379-2184
Phone
(320) 252-6525
Fax
(320) 259-3463
NPI assigned
Dec 13, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 13, 2021

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

Authorized official

Name
Mr. Michael Stordahl
Title
Administrator Ceo
Phone
(320) 252-6525

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Assisted Living Facility 310400000X
Alzheimer Center (Dementia Center) 311500000X 333736 MN Primary

Addresses

Primary practice location

307 11TH St N
Sauk Rapids, MN 56379-2184

Mailing address

1115 4TH Ave N
Sauk Rapids, MN 56379-2201
Phone (320) 252-6525

Other identifiers 1

IdentifierTypeStateIssuer
1396807962MedicaidMN

Other names 2

  • Good Shepherd Cottages Doing business as
  • Good Shepherd Memory Loss Cottages Doing business as

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
24D2232293Good Shepherd Cottages307 11TH Street N, Sauk Rapids, MN 56379Certificate of waiverAug 11, 2027

National Provider Directory

National Provider Directory
Tax ID family
Good Shepherd Cottages7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

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

Locations

307 11th St N
Sauk Rapids, MN 56379
Phone (320) 252-6525

NPI Registry JSON

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

{
    "created_epoch": "1165968000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1628812800000",
    "number": "1396807962",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1115 4TH AVE N",
            "city": "SAUK RAPIDS",
            "state": "MN",
            "postal_code": "563792201",
            "telephone_number": "320-252-6525",
            "fax_number": "320-259-3463"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "307 11TH ST N",
            "city": "SAUK RAPIDS",
            "state": "MN",
            "postal_code": "563792184",
            "telephone_number": "320-252-6525",
            "fax_number": "320-259-3463"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GOOD SHEPHERD LUTHERAN HOME OF SAUK RAPIDS, MN, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-13",
        "last_updated": "2021-08-13",
        "certification_date": "2021-08-13",
        "status": "A",
        "authorized_official_last_name": "STORDAHL",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_title_or_position": "ADMINISTRATOR CEO",
        "authorized_official_telephone_number": "320-252-6525",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "311500000X",
            "taxonomy_group": "",
            "desc": "Alzheimer Center (Dementia Center)",
            "state": "MN",
            "license": "333736",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1396807962",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Good Shepherd Cottages",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Good Shepherd Memory Loss Cottages",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Sauk Rapids, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 13, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.