NPIMap

Organization Active NPI

Prairie Pines Community

Doing business as Essentia Health Fosston

  • Assisted Living Facility
  • Fosston, MN
National Provider Identifier
1407268642
Registry record updated Oct 1, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Assisted Living FacilityTaxonomy code 310400000X
License
364748 Issued in MN
Legal business name
PRAIRIE PINES COMMUNITY
Doing business as
Essentia Health Fosston
Practice address
903 Praire Pines Drive
Fosston, MN 56542
Phone
(218) 435-7682
Fax
(701) 364-8476
NPI assigned
May 22, 2014
Last updated
Oct 1, 2021By the provider in NPPES
Organization subpart
Yes
Parent organization
FIRST CARE MEDICAL SERVICESAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 1, 2021

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

Authorized official

Name
Kim Bodensteiner
Title
Cfo
Phone
(218) 435-7633

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Assisted Living Facility 310400000X 364748 MN Primary

Addresses

Primary practice location

903 Praire Pines Drive
Fosston, MN 56542

Mailing address

900 Hilligoss Blvd SE
Fosston, MN 56542-1542
Phone (218) 435-1134

Other names 1

  • Essentia Health Fosston Doing business as

National Provider Directory

National Provider Directory
Tax ID family
First Care Medical Services5 organizations share this tax ID, including this one
Part of
First Care Medical Services

Other organizations with this tax ID 4

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

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1400716800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1633046400000",
    "number": "1407268642",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "900 HILLIGOSS BLVD SE",
            "city": "FOSSTON",
            "state": "MN",
            "postal_code": "565421542",
            "telephone_number": "218-435-1134",
            "fax_number": "701-364-8476"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "903 PRAIRE PINES DRIVE",
            "city": "FOSSTON",
            "state": "MN",
            "postal_code": "56542",
            "telephone_number": "218-435-7682",
            "fax_number": "701-364-8476"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRAIRIE PINES COMMUNITY",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "FIRST CARE MEDICAL SERVICES",
        "enumeration_date": "2014-05-22",
        "last_updated": "2021-10-01",
        "certification_date": "2021-10-01",
        "status": "A",
        "authorized_official_last_name": "BODENSTEINER",
        "authorized_official_first_name": "KIM",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "218-435-7633"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "MN",
            "license": "364748",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Essentia Health Fosston",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Essentia Health Fosston",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fosston, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 1, 2021; 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.