Bickford of North Branch, LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

25046 Issued in MN

Legal business name

BICKFORD OF NORTH BRANCH, LLC

Practice address

38610 14TH Ave
North Branch, MN 55056-6093

Phone

(651) 674-0068

NPI assigned

Mar 9, 2018

Last updated

Mar 9, 2018By 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

Alan Fairbanks

Title

Executive VP

Phone

(913) 782-3200

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1520553600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1520553600000",
    "number": "1568965242",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13795 S MUR LEN RD STE 301",
            "city": "OLATHE",
            "state": "KS",
            "postal_code": "660621096",
            "telephone_number": "913-782-3200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "38610 14TH AVE",
            "city": "NORTH BRANCH",
            "state": "MN",
            "postal_code": "550566093",
            "telephone_number": "651-674-0068"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BICKFORD OF NORTH BRANCH, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-03-09",
        "last_updated": "2018-03-09",
        "status": "A",
        "authorized_official_last_name": "FAIRBANKS",
        "authorized_official_first_name": "ALAN",
        "authorized_official_title_or_position": "EXECUTIVE VP",
        "authorized_official_telephone_number": "913-782-3200"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "MN",
            "license": "25046",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 9, 2018; 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.