NPIMap

Organization Active NPI

Autumn Woods III, LLC

Doing business as The Legacy of St. Anthony

  • Assisted Living Facility
  • St Anthony, MN
National Provider Identifier
1437507332
Registry record updated Jun 1, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Assisted Living FacilityTaxonomy code 310400000X
License
374017 Issued in MN
Legal business name
AUTUMN WOODS III, LLC
Doing business as
The Legacy of St. Anthony
Practice address
2540 Kenzie Ter
St Anthony, MN 55418-4165
Phone
(952) 697-4681
Fax
(952) 925-5640
NPI assigned
Jun 1, 2016
Last updated
Jun 1, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 1, 2016

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

Authorized official

Name
Caitlin Goff
Title
Manager
Phone
(952) 697-4681

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Assisted Living Facility 310400000X 374017 MN Primary

Addresses

Primary practice location

2540 Kenzie Ter
St Anthony, MN 55418-4165

Mailing address

4601 Excelsior Blvd
Suite 650
Minneapolis, MN 55416-4960
Phone (952) 697-4681

Other names 1

  • The Legacy of St. Anthony Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Autumn Woods III LLC2 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.

Ownership & related parties

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

NPI Registry JSON

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

{
    "created_epoch": "1464739200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1464739200000",
    "number": "1437507332",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4601 EXCELSIOR BLVD",
            "address_2": "SUITE 650",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554164960",
            "telephone_number": "952-697-4681",
            "fax_number": "952-925-5640"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2540 KENZIE TER",
            "city": "ST ANTHONY",
            "state": "MN",
            "postal_code": "554184165",
            "telephone_number": "952-697-4681",
            "fax_number": "952-925-5640"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AUTUMN WOODS III, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-06-01",
        "last_updated": "2016-06-01",
        "status": "A",
        "authorized_official_last_name": "GOFF",
        "authorized_official_first_name": "CAITLIN",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "952-697-4681"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "MN",
            "license": "374017",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The Legacy of St. Anthony",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in St Anthony, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 1, 2016; 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.