Legacy Senior Services

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

00669 Issued in MN

Legal business name

LEGACY SENIOR SERVICES

Doing business as

Traverse Care Center

Practice address

303 7TH St S
Wheaton, MN 56296-1740

Phone

(320) 563-8124

Fax

(320) 563-4133

NPI assigned

Jun 20, 2005

Last updated

Apr 9, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Eric R Lunde

Title

Board Member

Phone

(612) 695-5618

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Traverse Care Center Doing business as

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

• Legacy Senior Services

  dba Frazee Care Center

  • Skilled Nursing Facility
  • Frazee, MN
  • NPI 1255510889

  Member Of

  NPD member

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Patrick E Emery, MD

  • Family Medicine Physician
  • Wahpeton, ND
  • NPI 1144247008
  NPD (past)

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

{
    "created_epoch": "1119225600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1586390400000",
    "number": "1558366146",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "303 7TH ST S",
            "city": "WHEATON",
            "state": "MN",
            "postal_code": "562961740"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "303 7TH ST S",
            "city": "WHEATON",
            "state": "MN",
            "postal_code": "562961740",
            "telephone_number": "320-563-8124",
            "fax_number": "320-563-4133"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LEGACY SENIOR SERVICES",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-06-20",
        "last_updated": "2020-04-09",
        "certification_date": "2020-04-09",
        "status": "A",
        "authorized_official_last_name": "LUNDE",
        "authorized_official_first_name": "ERIC",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "BOARD MEMBER",
        "authorized_official_telephone_number": "612-695-5618"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "MN",
            "license": "00669",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "145240100",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF MINNESOTA",
            "identifier": "9264TR",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Traverse Care Center",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Traverse Care Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Ind School Dist No 803 - Traverse Co
• Paige Elizabeth Jenson, PA
• Kathi Jo Kremer, C.F.N.P.
• George H Kuzma, MD
• Lake Valley Dental PLLC
• Jill M Lemke, O.T.
• Michael Robert Marchetti, DDS
• Meritcare Wheaton Medical Center (MeritCare Wheaton Medical Center Pharmacy)
• Minnewaska Community Homecare LLC
• Mitteness Chiropractic Clinic

• Skilled Nursing Facility in Wheaton, MN
• Providers in Wheaton, MN by specialty
• Skilled Nursing Facility in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 9, 2020; 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.