NPIMap

Organization Active NPI

Country Manor Campus LLC

  • Long Term Care Pharmacy
  • Sartell, MN
National Provider Identifier
1497929558
Registry record updated Jun 30, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Long Term Care PharmacyTaxonomy code 3336L0003X
License
262882 Issued in MN
Legal business name
COUNTRY MANOR CAMPUS LLC
Practice address
520 1St St NE
Suite a
Sartell, MN 56377-1274
Phone
(320) 255-0801
Fax
(320) 230-3825
NPI assigned
Apr 18, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 30, 2021

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

Authorized official

Name
Joshua Lemm
Title
Pharmacist in Charge
Phone
(320) 255-0801

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X
Pharmacy 333600000X
Long Term Care Pharmacy 3336L0003X 262882 MN Primary

Addresses

Primary practice location

520 1St St NE
Suite a
Sartell, MN 56377-1274

Mailing address

520 1St St NE
Suite a
Sartell, MN 56377-1274
Phone (320) 255-0801

Other identifiers 1

IdentifierTypeStateIssuer
2125115OtherPK

Other names 1

  • Country Manor LTC Pharmacy Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Country Manor Campus LLC9 organizations share this tax ID, including this one

Other organizations with this tax ID 8

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

Ownership & related parties

Subparts reporting this organization as parent 3

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": "1208476800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1625011200000",
    "number": "1497929558",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "520 1ST ST NE",
            "address_2": "SUITE A",
            "city": "SARTELL",
            "state": "MN",
            "postal_code": "563771274",
            "telephone_number": "320-255-0801",
            "fax_number": "320-230-3825"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "520 1ST ST NE",
            "address_2": "SUITE A",
            "city": "SARTELL",
            "state": "MN",
            "postal_code": "563771274",
            "telephone_number": "320-255-0801",
            "fax_number": "320-230-3825"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COUNTRY MANOR CAMPUS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-04-18",
        "last_updated": "2021-06-30",
        "certification_date": "2021-06-30",
        "status": "A",
        "authorized_official_last_name": "LEMM",
        "authorized_official_first_name": "JOSHUA",
        "authorized_official_title_or_position": "PHARMACIST IN CHARGE",
        "authorized_official_telephone_number": "320-255-0801"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": "MN",
            "license": "262882",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2125115",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Country Manor LTC Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Country Manor LTC Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Sartell, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 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.