Minnetonka Assisted Living and Hospice

Primary specialty

Community Health WorkerTaxonomy code 172V00000X

License

383702 Issued in MN

Legal business name

MINNETONKA ASSISTED LIVING AND HOSPICE

Practice address

14667 Lake Street Extension
Minnetonka, MN 55345

Phone

(952) 405-6960

NPI assigned

Sep 26, 2017

Organization subpart

No

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

Authorized official

Name

Somachanary Kristie Kuoch, CAREGIVER

Title

Owner

Phone

(952) 405-6960

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1506384000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1497264147",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14667 LAKE STREET EXT",
            "city": "MINNETONKA",
            "state": "MN",
            "postal_code": "553452926",
            "telephone_number": "952-405-6960"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14667 LAKE STREET EXTENSION",
            "city": "MINNETONKA",
            "state": "MN",
            "postal_code": "55345",
            "telephone_number": "952-405-6960"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MINNETONKA ASSISTED LIVING AND HOSPICE",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-09-26",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "KUOCH",
        "authorized_official_first_name": "SOMACHANARY",
        "authorized_official_middle_name": "KRISTIE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "952-405-6960",
        "authorized_official_credential": "CAREGIVER"
    },
    "taxonomies": [
        {
            "code": "172V00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Community Health Worker",
            "state": "MN",
            "license": "383702",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "82121568",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Community Health Worker in Minnetonka, MN
• Providers in Minnetonka, MN by specialty
• Community Health Worker in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.