Camilia Rose Group Home

Primary specialty

Intellectual Disabilities Intermediate Care FacilityTaxonomy code 315P00000X

License

1075259 Issued in MN

Legal business name

CAMILIA ROSE GROUP HOME

Practice address

1555 118TH LN NW
Coon Rapids, MN 55448-7579

Phone

(763) 862-5436

Fax

(763) 754-0332

NPI assigned

Feb 7, 2007

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Connie Winbauer

Title

Controller

Phone

(763) 862-5436

Specialties & licenses 1

Addresses

Other names 1

• MARY T ASSOCIATES Other name

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

{
    "created_epoch": "1170806400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1447390570",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1555 118TH LN NW",
            "city": "COON RAPIDS",
            "state": "MN",
            "postal_code": "554487579",
            "telephone_number": "763-862-5436",
            "fax_number": "763-754-0332"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1555 118TH LN NW",
            "city": "COON RAPIDS",
            "state": "MN",
            "postal_code": "554487579",
            "telephone_number": "763-862-5436",
            "fax_number": "763-754-0332"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CAMILIA ROSE GROUP HOME",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-07",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "WINBAUER",
        "authorized_official_first_name": "CONNIE",
        "authorized_official_title_or_position": "CONTROLLER",
        "authorized_official_telephone_number": "763-862-5436"
    },
    "taxonomies": [
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": "MN",
            "license": "1075259",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MARY T ASSOCIATES",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Cassandra M Calendine, LAC
• Dennis John Callahan, MD
• Catherine M Callaway, CRNA
• James Adair Cameron, M.D.
• Camilia Rose Company Inc (Camilia Rose Care Center LLC)
• Leah R Campbell
• Kelsey Canfield, MS, OTR/L
• Romero Cannady
• Keith A Canter, D.P.M.
• Daniel Keith Cantwell, D.O.

• Intellectual Disabilities Intermediate Care Facility in Coon Rapids, MN
• Providers in Coon Rapids, MN by specialty
• Intellectual Disabilities Intermediate Care Facility in Minnesota

• 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.