The Homestead at Coon Rapids, Inc.

Primary specialty

Assisted Living Facility (Mental Illness)Taxonomy code 3104A0625X

Legal business name

THE HOMESTEAD AT COON RAPIDS, INC.

Practice address

1770 113TH LN NW
Coon Rapids, MN 55433-3019

Phone

(763) 754-2800

Fax

(763) 754-4800

NPI assigned

Mar 11, 2019

Organization subpart

No

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

Authorized official

Name

Nancy Gavin

Title

Assistant Secretary

Phone

(952) 983-4249

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1552262400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1612483200000",
    "number": "1508324443",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1770 113TH LN NW",
            "city": "COON RAPIDS",
            "state": "MN",
            "postal_code": "554333019",
            "telephone_number": "763-754-2800",
            "fax_number": "763-754-4800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1770 113TH LN NW",
            "city": "COON RAPIDS",
            "state": "MN",
            "postal_code": "554333019",
            "telephone_number": "763-754-2800",
            "fax_number": "763-754-4800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE HOMESTEAD AT COON RAPIDS, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-03-11",
        "last_updated": "2021-02-05",
        "certification_date": "2021-02-05",
        "status": "A",
        "authorized_official_last_name": "GAVIN",
        "authorized_official_first_name": "NANCY",
        "authorized_official_title_or_position": "ASSISTANT SECRETARY",
        "authorized_official_telephone_number": "952-983-4249"
    },
    "taxonomies": [
        {
            "code": "3104A0625X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility, Assisted Living, Mental Illness",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PENDING",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Andrew Thao
• Ching Yeng Thao
• Edwin Ma Thao
• Samantha Thayer, OTR/L
• The Fountains Living LLC
• The Homestead at Coon Rapids, Inc.
• The Menage
• The Winkley Company
• Mary Jo Theis, COTA
• Therapy Partners Inc

• All providers in Coon Rapids, MN
• Assisted Living Facility (Mental Illness) in Minnesota

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