The Homestead at Coon Rapids, Inc.

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

Legal business name

THE HOMESTEAD AT COON RAPIDS, INC.

Doing business as

The Homestead at Coon Rapids

Practice address

11372 Robinson Dr NW
Coon Rapids, MN 55433-4071

Phone

(763) 233-5100

NPI assigned

Feb 4, 2019

Last updated

Feb 5, 2021By 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

Nancy Gavin

Title

Assistant Secretary/Assistant Treas

Phone

(952) 983-4249

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• The Homestead at Coon Rapids Doing business as

Locations

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

{
    "created_epoch": "1549238400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1612483200000",
    "number": "1578028585",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11372 ROBINSON DR NW",
            "city": "COON RAPIDS",
            "state": "MN",
            "postal_code": "554334071",
            "telephone_number": "763-233-5100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11372 ROBINSON DR NW",
            "city": "COON RAPIDS",
            "state": "MN",
            "postal_code": "554334071",
            "telephone_number": "763-233-5100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE HOMESTEAD AT COON RAPIDS, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-02-04",
        "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/ASSISTANT TREAS",
        "authorized_official_telephone_number": "952-983-4249"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PENDING",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The Homestead at Coon Rapids",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• 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 (Winkley Orthotics and Prosthetics)
• Mary Jo Theis, COTA
• Therapy Partners Inc
• Andrew Thielke

• 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 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.