Autumn Glen Senior Living LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

372324 Issued in MN

Legal business name

AUTUMN GLEN SENIOR LIVING LLC

Practice address

3715 Coon Rapids Blvd NW
Coon Rapids, MN 55433-2777

Phone

(763) 772-4492

Fax

(763) 746-4080

NPI assigned

Dec 26, 2015

Organization subpart

No

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

Authorized official

Name

Kristin Neff

Title

Chief Operations Officer

Phone

(763) 241-4428

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1451088000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1451088000000",
    "number": "1508221136",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3715 COON RAPIDS BLVD NW",
            "city": "COON RAPIDS",
            "state": "MN",
            "postal_code": "554332777",
            "telephone_number": "763-772-4492",
            "fax_number": "763-746-4080"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3715 COON RAPIDS BLVD NW",
            "city": "COON RAPIDS",
            "state": "MN",
            "postal_code": "554332777",
            "telephone_number": "763-772-4492",
            "fax_number": "763-746-4080"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "AUTUMN GLEN SENIOR LIVING LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-12-26",
        "last_updated": "2015-12-26",
        "status": "A",
        "authorized_official_last_name": "NEFF",
        "authorized_official_first_name": "KRISTIN",
        "authorized_official_title_or_position": "CHIEF OPERATIONS OFFICER",
        "authorized_official_telephone_number": "763-241-4428"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "MN",
            "license": "372324",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Paul L. Aubart, RN
• Joylene Mae Audette, PT
• Thomas Anthony Aulwes, DDS
• Michael Ausmus, PHARMD
• Jay Aust, B.A.,B.S.,M.A.,AU.D.
• Anna Laurie Averbeck, PHARM/ D
• Paola Nicole Aviles Crespo
• Bridget C Axelson, O.D.
• Oluwasola J Ayodele
• Jeffrey Babb

• Assisted Living Facility in Coon Rapids, MN
• Providers in Coon Rapids, MN by specialty
• Assisted Living Facility in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 26, 2015; 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.