Glendalough of Austin, Inc.

Primary specialty

Intellectual Disabilities Intermediate Care FacilityTaxonomy code 315P00000X

License

804833 2 RS Issued in MN

Legal business name

GLENDALOUGH OF AUSTIN, INC.

Practice address

1409 12TH Ave NW
Austin, MN 55912-1912

Phone

(507) 433-6499

NPI assigned

Nov 28, 2006

Organization subpart

No

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

Authorized official

Name

Mr. Russ Kennedy

Title

Ceo

Phone

(507) 334-4347

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1164672000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1396811519",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "402 HERITAGE PL",
            "city": "FARIBAULT",
            "state": "MN",
            "postal_code": "550215248",
            "telephone_number": "507-334-4347"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1409 12TH AVE NW",
            "city": "AUSTIN",
            "state": "MN",
            "postal_code": "559121912",
            "telephone_number": "507-433-6499"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GLENDALOUGH OF AUSTIN, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-28",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "KENNEDY",
        "authorized_official_first_name": "RUSS",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "507-334-4347",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": "MN",
            "license": "804833 2 RS",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.