NPIMap

Organization Active NPI

Rem Heartland, Inc.

  • Assisted Living Facility (Mental Illness)
  • Fairmont, MN
National Provider Identifier
1477854289
Registry record updated Mar 5, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Assisted Living Facility (Mental Illness)Taxonomy code 3104A0625X
License
803838-2-WS Issued in MN
Legal business name
REM HEARTLAND, INC.
Practice address
1205 Victoria St
Fairmont, MN 56031-4453
Phone
(952) 922-6776
Fax
(952) 922-6885
NPI assigned
Nov 10, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 5, 2023

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

Authorized official

Name
Bret Ian Cohen
Title
Coo
Phone
(800) 388-5150

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Assisted Living Facility (Mental Illness) 3104A0625X 803838-2-WS MN Primary

Addresses

Primary practice location

1205 Victoria St
Fairmont, MN 56031-4453

Mailing address

6600 France Ave S
Edina, MN 55435-1805
Phone (952) 922-6776

Other identifiers 2

IdentifierTypeStateIssuer
803838-2-WSMedicaidMN
UNKNOWNOtherMNCERTIFICATE OF REGISTRACTION MN DEPARTMENT OF HEALTH

Other names 1

  • REM Heartland, Inc. Odyssey Other name

National Provider Directory

National Provider Directory
Tax ID family
Rem Heartland Inc7 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.

NPI Registry JSON

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

{
    "created_epoch": "1289347200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1677974400000",
    "number": "1477854289",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6600 FRANCE AVE S",
            "city": "EDINA",
            "state": "MN",
            "postal_code": "554351805",
            "telephone_number": "952-922-6776",
            "fax_number": "952-922-6885"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1205 VICTORIA ST",
            "city": "FAIRMONT",
            "state": "MN",
            "postal_code": "560314453",
            "telephone_number": "952-922-6776",
            "fax_number": "952-922-6885"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "REM HEARTLAND, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-11-10",
        "last_updated": "2023-03-05",
        "certification_date": "2023-03-05",
        "status": "A",
        "authorized_official_last_name": "COHEN",
        "authorized_official_first_name": "BRET",
        "authorized_official_middle_name": "IAN",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "800-388-5150"
    },
    "taxonomies": [
        {
            "code": "3104A0625X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility, Assisted Living, Mental Illness",
            "state": "MN",
            "license": "803838-2-WS",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "803838-2-WS",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CERTIFICATE OF REGISTRACTION MN DEPARTMENT OF HEALTH",
            "identifier": "UNKNOWN",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "REM Heartland, Inc. Odyssey",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "REM Heartland, Inc. Odyssey",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Fairmont, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 5, 2023; 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.